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Stitz R, Stoiber F, Silye R, Vlachos G, Andaloro S, Rebhan E, Dunzinger M, Pühringer F, Gallo C, El-Heliebi A, Heitzer E, Hauser-Kronberger C. Clinical Implementation of a Noninvasive, Multi-Analyte Droplet Digital PCR Test to Screen for Androgen Receptor Alterations. J Mol Diagn 2024:S1525-1578(24)00061-8. [PMID: 38522838 DOI: 10.1016/j.jmoldx.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/14/2024] [Accepted: 02/13/2024] [Indexed: 03/26/2024] Open
Abstract
Alterations of the androgen receptor (AR) are associated with resistance to AR-directed therapy in prostate cancer. Thus, it is crucial to develop robust detection methods for AR alterations as predictive biomarkers to enable applicability in clinical practice. We designed and validated five multiplex droplet digital PCR assays for reliable detection of 12 AR targets including AR amplification, AR splice variant 7, and 10 AR hotspot mutations, as well as AR and KLK3 gene expression from plasma-derived cell-free DNA and cell-free RNA. The assays demonstrated excellent analytical sensitivity and specificity ranging from 95% to 100% (95% CI, 75% to 100%). Intrarun and interrun variation analyses revealed a high level of repeatability and reproducibility. The developed assays were applied further in peripheral blood samples from 77 patients with advanced prostate cancer to assess their feasibility in a real-world scenario. Optimizing the reverse transcription of RNA increased the yield of plasma-derived cell-free RNA by 30-fold. Among 23 patients with castration-resistant prostate cancer, 6 patients (26.1%) had one or a combination of several AR alterations, whereas only 2 of 54 patients (3.7%) in the hormone-sensitive stage showed AR alterations. These findings were consistent with other studies and suggest that implementation of comprehensive AR status detection in clinical practice is feasible and can support the treatment decision-making process.
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Affiliation(s)
- Regina Stitz
- Department of Pathology, Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria; Doctoral Program Medical Science, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Franz Stoiber
- Department of Urology Medicine, Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria
| | - Renè Silye
- Department of Pathology, Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria
| | - Georgios Vlachos
- Institute of Human Genetics, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria; Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, Medical University of Graz, Graz, Austria
| | - Silvia Andaloro
- Institute of Human Genetics, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria
| | - Elisabeth Rebhan
- Department of Pathology, Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria
| | - Michael Dunzinger
- Department of Urology Medicine, Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria
| | - Franz Pühringer
- Department of Pathology, Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria
| | - Caroline Gallo
- Department of Pathology, Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria
| | - Amin El-Heliebi
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre, Medical University of Graz, Graz, Austria; BioTechMed-Graz, Graz, Austria
| | - Ellen Heitzer
- Institute of Human Genetics, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria; Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, Medical University of Graz, Graz, Austria.
| | - Cornelia Hauser-Kronberger
- Department of Pathology, Salzkammergutklinikum Vöcklabruck, Vöcklabruck, Austria; Department of Anatomy and Cell Biology, Paracelsus Medical University Salzburg, Salzburg, Austria.
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Mylonakis M, Tserevelakis GJ, Vlachos G, Fanouraki E, Pavlopoulos A, Pavlidis M, Zacharakis G. Bimodal optical and optoacoustic multiview microscope in the frequency-domain. Opt Lett 2024; 49:462-465. [PMID: 38300031 DOI: 10.1364/ol.510384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/14/2023] [Indexed: 02/02/2024]
Abstract
Hybrid fluorescence and optoacoustic microscopy systems have recently emerged as powerful imaging modalities concurrently capturing both radiative and non-radiative molecular relaxations in biological tissues. Nevertheless, such approaches provide limited information as specimens are imaged exclusively from one side, not permitting the acquisition of their full anatomical, structural, or functional features in multiple views of interest. Herein we present a bimodal optical and optoacoustic multiview (BOOM) cost-efficient microscope operating in the frequency-domain for the comprehensive label-free imaging of established and emerging model organisms. Thus, the capabilities of BOOM microscopy have been proven suitable for highly demanding observations in developmental biology and embryology.
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Moser T, Kühberger S, Lazzeri I, Vlachos G, Heitzer E. Bridging biological cfDNA features and machine learning approaches. Trends Genet 2023; 39:285-307. [PMID: 36792446 DOI: 10.1016/j.tig.2023.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 06/29/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
Liquid biopsies (LBs), particularly using circulating tumor DNA (ctDNA), are expected to revolutionize precision oncology and blood-based cancer screening. Recent technological improvements, in combination with the ever-growing understanding of cell-free DNA (cfDNA) biology, are enabling the detection of tumor-specific changes with extremely high resolution and new analysis concepts beyond genetic alterations, including methylomics, fragmentomics, and nucleosomics. The interrogation of a large number of markers and the high complexity of data render traditional correlation methods insufficient. In this regard, machine learning (ML) algorithms are increasingly being used to decipher disease- and tissue-specific signals from cfDNA. Here, we review recent insights into biological ctDNA features and how these are incorporated into sophisticated ML applications.
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Affiliation(s)
- Tina Moser
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, Medical University of Graz, Graz, Austria
| | - Stefan Kühberger
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, Medical University of Graz, Graz, Austria
| | - Isaac Lazzeri
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, Medical University of Graz, Graz, Austria
| | - Georgios Vlachos
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, Medical University of Graz, Graz, Austria
| | - Ellen Heitzer
- Institute of Human Genetics, Diagnostic & Research Center for Molecular BioMedicine, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, Medical University of Graz, Graz, Austria.
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4
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Vlachos G, Ihle-Hansen H, Wyller TB, Brækhus A, Mangset M, Hamre C, Fure B. Factors determining not returning to full-time work 12 months following mild ischemic stroke. Arch Rehabil Res Clin Transl 2022; 5:100245. [PMID: 36968174 PMCID: PMC10036226 DOI: 10.1016/j.arrct.2022.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate prevalence and factors determining not returning to full-time work 1 year after first-ever mild ischemic stroke. Design Prospective, observational cohort study with 12-month follow-up. Setting Stroke units and outpatient clinics at 2 Norwegian hospitals. Participants We included 84 (N=84) full-time working, cognitively healthy patients aged 70 years or younger who suffered an acute first-ever mild ischemic stroke, defined as National Institutes of Health Stroke Scale (NIHSS) score ≤3 points. Interventions Not applicable. Main Outcome Measures Vascular risk factors, sociodemographic factors, stroke localization, and etiology were recorded at inclusion. Cognitive impairment, anxiety, depression, fatigue, and apathy 12 months after stroke were assessed with validated instruments. Logistic regression analyses were performed to find correlates of not returning to full-time employment. Results Of 78 patients assessed 1 year after stroke, 63 (81%) had returned to work, 47 (60%) to full-time employment status. Modified Rankin scale score >1 (adjusted odds ratio, 12.44 [95% confidence interval, 2.37-65.43], P=.003) at follow-up was significantly associated, and diabetes (adjusted odds ratio, 10.56 [95% confidence interval, 0.98-113.47], P=.052) was borderline significantly associated with not returning to full-time work. Female sex, NIHSS at discharge, anxiety per point on the anxiety scale, depression per point on the depression scale, and fatigue per point on the fatigue scale were significantly associated with not returning to full-time work after 1 year, but these associations were only seen in the unadjusted models. Conclusions Low functional level that persists 12 months after stroke is related to not returning to full-time work. Patients with diabetes mellitus, female patients, and patients with a higher score on fatigue, anxiety, and depression scales may also be at risk of not returning to full-time work post stroke. Working patients should be followed up with a particular focus on factors determining participation in work and social life.
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Vlachos G, Ihle-Hansen H, Wyller TB, Brækhus A, Mangset M, Hamre C, Fure B. Predictors of cognitive and emotional symptoms 12 months after first-ever mild stroke. Neuropsychol Rehabil 2022; 33:662-679. [PMID: 35196958 DOI: 10.1080/09602011.2022.2038211] [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
Even mild strokes may affect the patients' everyday life by impairing cognitive and emotional functions. Our aim was to study predictors of such impairments one year after first-ever mild stroke. We included cognitively healthy patients ≤ 70 years with acute mild stroke. Vascular risk factors, sociodemographic factors and stroke classifications were recorded. At one-year post-stroke, different domains related to cognitive and emotional function were assessed with validated instruments. Logistic regression analyses were performed to identify predictors of cognitive and emotional outcome. Of 117 patient assessed at follow-up, only 21 patients (18%) scored within the reference range on all cognitive and emotional assessments. Younger age, multiple infarcts, and being outside working life at stroke onset were independent predictors of cognitive impairments (psychomotor speed, attention, executive and visuospatial function, memory). Female gender and a higher National Institutes of Health Stroke Scale (NIHSS) score at discharge were significantly associated with emotional impairments (anxiety, depressive symptoms, fatigue, apathy, emotional lability) after one year, but these associations were only seen in the unadjusted models. In conclusion, patients in working age may profit from a follow-up during the post-stroke period, with extra focus on cognitive and emotional functions.
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Affiliation(s)
- Georgios Vlachos
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Department of Internal Medicine, Bærum Hospital, Vestre Viken, Norway
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Brækhus
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Charlotta Hamre
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Physiotherapy, Oslo University Hospital, Oslo, Norway
| | - Brynjar Fure
- Department of Internal Medicine, Central Hospital, Karlstad, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
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Vlachos DE, Protopapas A, Vlachos G, Sarris K, Sotiropoulou M, Terzi M, Loutradis D. Menstural function preservation treatment of a primary vaginal clear cell carcinoma with ovarian transposition and vaginal brachytherapy. Gynecol Oncol Rep 2021; 36:100764. [PMID: 33912644 PMCID: PMC8063755 DOI: 10.1016/j.gore.2021.100764] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 11/27/2022] Open
Abstract
Early stage vaginal carcinomas are typically treated with radical surgical procedures or radiation therapy. Both modalities impair the reproductive ability of the patients. We hereby report a case of menstrual function preservation in a 24-year-old patient with an early-stage primary vaginal clear cell carcinoma. We treated the patient with intravaginal brachytherapy after appropriate laparoscopic surgical staging and separate transposition of the ovaries and tubes. The patient is now 6 years without any evidence of disease. She reports minor. complaints during sexual intercourse, while her menstruation and hormonic profile are normal.
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Affiliation(s)
| | | | - Georgios Vlachos
- 1st Department of Obstetrics and Gynecology, University of Athens, Greece
| | - Kyrillos Sarris
- Department of Radiotherapy, General Hospital "Alexandra", Athens, Greece
| | | | - Maria Terzi
- Department of Pathology, 'Hygeia' Diagnostic and Therapeutic Centre of Athens - Hygeia, Greece
| | - Dimitris Loutradis
- 1st Department of Obstetrics and Gynecology, University of Athens, Greece
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Hamre C, Fure B, Helbostad JL, Wyller TB, Ihle-Hansen H, Vlachos G, Ursin MH, Tangen GG. Factors Associated with Level of Physical Activity After Minor Stroke. J Stroke Cerebrovasc Dis 2021; 30:105628. [PMID: 33508728 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/27/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To explore factors from the acute phase, and after three and 12 months, associated with level of self-reported physical activity 12 months after a minor ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 in persons 70 years or younger. MATERIALS AND METHOD In this longitudinal cohort study patients were recruited consecutively from two stroke units. Activity level were measured with three sets of questions addressing the average number of frequency (times exercising each week), the average intensity, and duration (the average time), and a sum score was constructed. The association between physical activity 12 months after stroke and sociodemographic factors, NIHSS, body mass index, balance, and neuropsychiatric symptoms were explored using multiple linear regression. RESULTS This study included 101 patients, with mean age (SD) 55.5 (11.4) years, NIHSS median (Q1, Q3) 0.0 (0.0, 1.0), and 20 % were female. Multiple linear regression analyses showed sick leave status at stroke onset, balance at three and 12 months, and anxiety, depression, apathy, and fatigue at 12 months to be factors associated with physical activity at 12 months after stroke. CONCLUSION We found that pre-stroke sick leave, post-stroke balance, and neuropsychiatric symptoms were associated with the level of physical activity one year after minor stroke. This might be of importance when giving information about physical activity and deciding about post-stroke follow-up.
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Affiliation(s)
- Charlotta Hamre
- Department of Physiotherapy, Oslo University Hospital (OUS), Norway; Department of Geriatric Medicine, OUS, Norway; Institute of Clinical Medicine, University of Oslo (UiO), Norway; Department of Neurology, OUS, Norway.
| | - Brynjar Fure
- Department of Internal Medicine, Central Hospital, Karlstad, Sweden; Department of Neurology, Central Hospital, Karlstad and Örebro, Sweden; School of Medical Sciences, Örebro University, Sweden.
| | - Jorunn Lægdheim Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Norway.
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, OUS, Norway; Institute of Clinical Medicine, University of Oslo (UiO), Norway.
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, OUS, Norway; Department of Neurology, OUS, Norway.
| | | | - Marie Helene Ursin
- Department of Geriatric Medicine, Bærum Hospital, Vestre Viken Trust, Norway
| | - Gro Gujord Tangen
- Department of Geriatric Medicine, OUS, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway.
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Vlachos G, Ihle-Hansen H, Bruun Wyller T, Brækhus A, Mangset M, Hamre C, Fure B. Cognitive and emotional symptoms in patients with first-ever mild stroke: The syndrome of hidden impairments. J Rehabil Med 2021; 53:jrm00135. [PMID: 33145603 PMCID: PMC8772375 DOI: 10.2340/16501977-2764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of cognitive and emotional impairments one year after first-ever mild stroke in younger patients Design: Prospective, observational, cohort study. SUBJECTS A consecutive sample of 117 previously cognitively healthy patients aged 18-70 years with mild stroke (National Institutes of Health Stroke Scale score ≤ 3) were included in 2 hospitals in Norway during a 2-year period. METHODS At 12-month follow-up, patients were assessed using validated instruments for essential cognitive domains, fatigue, depression, anxiety, apathy and pathological laughter and crying. RESULTS In total, 78 patients (67%) had difficulty with one or a combination of the cognitive domains psychomotor speed, attention, executive and visuospatial function, and memory. Furthermore, 50 patients (43%) had impairment in either one or a combination of the emotional measures for anxiety, depressive symptoms, fatigue, apathy or emotional lability. A total of 32 patients (28%) had both cognitive and emotional impairments. Only 21 patients (18%) scored within the reference range in all the cognitive and emotional tools. CONCLUSION Hidden impairments are common after first-ever mild stroke in younger patients. Stroke physicians should screen for hidden impairments using appropriate tools.
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Affiliation(s)
- Georgios Vlachos
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. E-mail:
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Hamre C, Fure B, Helbostad JL, Wyller TB, Ihle-Hansen H, Vlachos G, Ursin M, Tangen GG. Balance and Gait After First Minor Ischemic Stroke in People 70 Years of Age or Younger: A Prospective Observational Cohort Study. Phys Ther 2020; 100:798-806. [PMID: 31944247 DOI: 10.1093/ptj/pzaa010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/22/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients <70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group. OBJECTIVE The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients ≤70 years with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤3). This study also explored factors predicting impaired balance after 12 months. DESIGN This study was designed as an explorative longitudinal cohort study. METHODS Patients were recruited consecutively from 2 stroke units. Balance and gait were assessed with the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, and preferred gait speed. Predictors for impaired balance were explored using logistic regression. RESULTS This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female, and mean (SD) National Institutes of Health Stroke Scale score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and Timed Up and Go improved significantly from the acute phase to 3 months, and gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio = 0.92, 95% confidence interval = 0.85-0.95) was the only predictor of balance impairments (Mini-BESTest score ≤22) at 12 months poststroke. LIMITATIONS Limitations include lack of information about pre-stroke balance and gait impairment and poststroke exercise. Few women limited the generalizability. CONCLUSION This study observed improvements in both balance and gait during the follow-up; still, about one-third had balance or gait impairments at 12 months poststroke. Balance in the acute phase predicted impaired balance at 12 months.
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Affiliation(s)
- Charlotta Hamre
- Department of Physiotherapy, Oslo University Hospital, Postboks 4956 Nydalen, Oslo 0424 Norway.,Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital
| | - Brynjar Fure
- Department of Internal Medicine and Department of Neurology, Central Hospital, Karlstad and School of Medical Sciences, Örebro University, Karlstad, Sweden
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torgeir B Wyller
- Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, Oslo University Hospital and Department of Neurology, Oslo University Hospital
| | - Georgios Vlachos
- Department of Geriatric Medicine, Oslo University Hospital and Department of Neurology, Oslo University Hospital
| | - Marie Ursin
- Department of Geriatric Medicine, Bærum Hospital, Vestre Viken Trust, Drammen, Norway
| | - Gro Gujord Tangen
- Department of Geriatric Medicine, Oslo University Hospital.,Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tonsberg, Norway.,Department of Interdisciplinary Health Sciences, University of Oslo
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Hamre C, Fure B, Helbostad JL, Wyller TB, Ihle-Hansen H, Vlachos G, Ursin MH, Tangen GG. Impairments in spatial navigation during walking in patients 70 years or younger with mild stroke. Top Stroke Rehabil 2020; 27:601-609. [PMID: 32316862 DOI: 10.1080/10749357.2020.1755814] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Spatial navigation, the ability to determine and maintain a route from one place to another, is needed for independence in everyday life. Knowledge about impairments in spatial navigation in people with mild stroke is scarce.Objectives: To explore impairments in spatial navigation in patients ≤70 years after first-ever mild ischemic stroke (NIHSS≤3) and to explore which variables are associated with these impairments 12 months later.Methods: Patients were examined in the acute phase, and after 3 and 12 months. To assess impairments in spatial navigation, we used the Floor Maze Test (FMT), with time and FMT-errors as outcomes. Patients' perceived navigational skills were collected using self-report. Logistic regression was used to explore which variables (sociodemographic data, stroke characteristics, cognition, and mobility) were associated with impaired navigation ability.Results: Ninety-seven patients (20 females) were included. The mean (SD) age was 55.5 (11.4) years. Timed FMT improved significantly from the acute phase to 12 months (p = <.001). At 12 months, 24 (24.7%) of the participants walked through the maze with errors, and 22 (22.7%) reported spatial navigational problems. The Trail Making Test (TMT)-B was the only variable from the acute phase associated with FMT-errors at 12 months, and being female was the only variable associated with self-reported navigational problems at 12 months.Conclusion: Nearly one in four patients experienced spatial navigation problems 12 months after a mild stroke. Executive function (TMT-B), measured in the acute phase, was associated with navigational impairments (FMT-errors) at 12 months, and being female was associated with self-reported navigational problems.
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Affiliation(s)
- Charlotta Hamre
- Department of Physiotherapy, Oslo University Hospital (OUS), Oslo, Norway.,Department of Geriatric Medicine, OUS, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo (UiO), Oslo, Norway.,Department of Neurology, OUS, Oslo, Norway
| | - Brynjar Fure
- Department of Internal Medicine, Central Hospital, Karlstad, Sweden.,Department of Neurology, Central Hospital, Karlstad and Örebro, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jorunn Lægdheim Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, OUS, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo (UiO), Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, OUS, Oslo, Norway.,Department of Neurology, OUS, Oslo, Norway
| | | | - Marie Helene Ursin
- Department of Geriatric Medicine, Bærum Hospital, Vestre Viken Trust, Bærum, Norway
| | - Gro Gujord Tangen
- Department of Geriatric Medicine, OUS, Oslo, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tönsberg, Norway.,Department of Interdisciplinary Health Sciences, UiO, Oslo, Norway
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Rodolakis A, Thomakos N, Sotiropoulou M, Kypriotis K, Valsamidis D, Bourgioti C, Moulopoulou LE, Vlachos G, Loutradis D. Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer During Pregnancy: A Provocative Surgical Approach. Overview of the Literature and a Single-Institute Experience. Int J Gynecol Cancer 2019; 28:1743-1750. [PMID: 30376483 DOI: 10.1097/igc.0000000000001357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Treatment of pregnancy complication due to malignancy of the cervix constitutes a great clinical challenge between optimal maternal therapy and fetal viability. Radical trachelectomy in early-stage cervical cancer during pregnancy instead of radical hysterectomy presents an alternative approach that can offer a satisfactory outcome for the mother and fetus. MATERIALS AND METHODS-RESULTS A literature search of articles in English has been performed. Until now, 28 women with cervical cancer, including 2 who were managed and treated in our institute, who underwent a radical trachelectomy during pregnancy have been reported. We overviewed a total of 13 abdominal trachelectomies, 13 vaginal trachelectomies, and 2 laparoscopic trachelectomies. CONCLUSIONS Radical trachelectomy can widen the therapeutic approach of early-stage cervical cancer in pregnant women who wish to preserve their pregnancy, providing a possibility of receiving the proper treatment with no delay.
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Affiliation(s)
- Alexandros Rodolakis
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
| | - Nikolaos Thomakos
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
| | | | - Konstantinos Kypriotis
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
| | | | - Charis Bourgioti
- Department of Radiology "Aretaieion" Hospital of National and Kapodistrian University of Athens, Athens, Greece
| | - Lia Evangelia Moulopoulou
- Department of Radiology "Aretaieion" Hospital of National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Vlachos
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
| | - Dimitrios Loutradis
- 1st Obstetric and Gynaecological Department of "Alexandra" Hospital of National and Kapodistrian University of Athens
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Trachana S, Thomakos N, Haidopoulos D, Sotiropoulou M, Vlachos D, Vlachos G, Rodolakis A. Does conservative treatment represents the best choice in women with adenocarcinoma in situ of the uterine cervix? A single-institutional study. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.424] [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: 11/17/2022]
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13
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Thomakos N, Biliatis I, Koutroumpa I, Sotiropoulou M, Bamias A, Liontos M, Vlachos G, Rodolakis A. Prognostic factors for recurrence in early stage adult granulosa cell tumor of the ovary. Arch Gynecol Obstet 2016; 294:1031-1036. [PMID: 27324782 DOI: 10.1007/s00404-016-4135-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 01/30/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Adult granulosa cell tumors (AGCTs) account for less than 5 % of all ovarian malignancies, whereas the majority (95 %) occurs after the age of 30 (adult-type) and present at an early stage. Aim of this study is to identify clinical and pathological risk factors for recurrence in early stage AGCTs. METHODS Retrospective review of patients with AGCT of the ovary, treated surgically at our institution from 1996 to 2011. Clinical, pathological and follow-up data were collected. Systematic analysis was performed to determine variables for predicting recurrence. RESULTS In total, 43 patients were identified. The mean age at diagnosis was 54.3 years and 65.1 % of them were postmenopausal. All patients underwent surgical staging and intraoperative rupture of the tumor occurred in four of them (9.3 %). The majority of the cases were staged as IA (72.1 %) while 10 (23.3 %) were staged as IC and only two patients as IIB. Mitotic index was 4 or more in 34.9 % of the patients and nuclear atypia was moderate to high in 60.5 %. During follow-up period (mean 9.2 years), recurrence occurred in three patients (7 %) with no deaths recorded so far. The cumulative recurrence free rate for the first 2 years was 97.6 % (SE = 2.4 %), for 5 years 94.9 % (SE = 3.5 %) and for 10 years 91.0 % (SE = 5.1 %).Tumor size, stage and mitotic index proved to be independent predictors for recurrence at the multivariate analysis. CONCLUSIONS Recurrence in early stage AGCT seems to be associated with stage, tumor size and mitotic index. All the above should be taken into consideration when tailored postoperative management is planned.
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Affiliation(s)
- Nikolaos Thomakos
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece.
| | - Ioannis Biliatis
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece
| | - Ioanna Koutroumpa
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece
| | | | - Aris Bamias
- Department of Clinical Therapeutics, University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Georgios Vlachos
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology, University of Athens, "Alexandra" Hospital, 80, Vas. Sophias Ave, 11528, Athens, Greece
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Trachana SP, Pilalis E, Gavalas NG, Tzannis K, Papadodima O, Liontos M, Rodolakis A, Vlachos G, Thomakos N, Haidopoulos D, Lykka M, Koutsoukos K, Kostouros E, Terpos E, Chatziioannou A, Dimopoulos MA, Bamias A. The Development of an Angiogenic Protein "Signature" in Ovarian Cancer Ascites as a Tool for Biologic and Prognostic Profiling. PLoS One 2016; 11:e0156403. [PMID: 27258020 PMCID: PMC4892506 DOI: 10.1371/journal.pone.0156403] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 05/13/2016] [Indexed: 01/07/2023] Open
Abstract
Advanced ovarian cancer (AOC) is one of the leading lethal gynecological cancers in developed countries. Based on the important role of angiogenesis in ovarian cancer oncogenesis and expansion, we hypothesized that the development of an "angiogenic signature" might be helpful in prediction of prognosis and efficacy of anti-angiogenic therapies in this disease. Sixty-nine samples of ascitic fluid- 35 from platinum sensitive and 34 from platinum resistant patients managed with cytoreductive surgery and 1st-line carboplatin-based chemotherapy- were analyzed using the Proteome ProfilerTM Human Angiogenesis Array Kit, screening for the presence of 55 soluble angiogenesis-related factors. A protein profile based on the expression of a subset of 25 factors could accurately separate resistant from sensitive patients with a success rate of approximately 90%. The protein profile corresponding to the "sensitive" subset was associated with significantly longer PFS (8 [95% Confidence Interval {CI}: 8-9] vs. 20 months [95% CI: 15-28]; Hazard ratio {HR}: 8.3, p<0.001) and OS (20.5 months [95% CI: 13.5-30] vs. 74 months [95% CI: 36-not reached]; HR: 5.6 [95% CI: 2.8-11.2]; p<0.001). This prognostic performance was superior to that of stage, histology and residual disease after cytoreductive surgery and the levels of vascular endothelial growth factor (VEGF) in ascites. In conclusion, we developed an "angiogenic signature" for patients with AOC, which can be used, after appropriate validation, as a prognostic marker and a tool for selection for anti-angiogenic therapies.
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Affiliation(s)
- Sofia-Paraskevi Trachana
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
- * E-mail:
| | - Eleftherios Pilalis
- Metabolic Engineering and Bioinformatics Program Institute of Biology, Medicinal Chemistry & Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Nikos G. Gavalas
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Kimon Tzannis
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Olga Papadodima
- Metabolic Engineering and Bioinformatics Program Institute of Biology, Medicinal Chemistry & Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Georgios Vlachos
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Nikolaos Thomakos
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Dimitrios Haidopoulos
- First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Maria Lykka
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Konstantinos Koutsoukos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Efthimios Kostouros
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Evagelos Terpos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Aristotelis Chatziioannou
- Metabolic Engineering and Bioinformatics Program Institute of Biology, Medicinal Chemistry & Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
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Papatheodorou D, Thomakos N, Sotiropoulou M, Haidopoulos D, Mole Z, Davidovic-Grigoraki M, Bamias A, Vlachos G, Rodolakis A. A novel insight of pathological parameters involved in recurrence and survival of patients with vulvar cancer: The importance of perineural infiltration and patterns of invasion. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.236] [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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16
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Koutroumpa I, Thomakos N, Sotiropoulou M, Haidopoulos D, Papatheodorou D, Davidovic-Grigoraki M, Bamias A, Vlachos G, Rodolakis A. When does the sentinel lymph node mapping support a less radical surgery in the management of early stage cervical cancer? A single institutional prospective study. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.102] [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: 10/21/2022]
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Vlachos G, Tsikouras P, Manav B, Trypsianis G, Liberis V, Karpathios S, Galazios G. The effect of the use of a new type of partogram on the cesarean section rates. J Turk Ger Gynecol Assoc 2015; 16:145-8. [PMID: 26401106 DOI: 10.5152/jtgga.2015.15074] [Citation(s) in RCA: 4] [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: 04/18/2015] [Accepted: 07/16/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the contribution of a new type of partogram, used in labor monitoring, in caesarean section rates. MATERIAL AND METHODS The study included term singleton uncomplicated pregnancies divided into two groups. Two types of partogram were used in labor monitoring. In the first group, the classical WHO partogram (A) was used. In the second group, a new type of partogram, in which cervical dilatation and the position of descending head (B) (one line) were estimated and reported, was used. The labor duration and caesarean section rates were calculated and compared in the two groups. RESULTS A statistically significant decrease in labor duration (from the initiation of the active phase of labor to the delivery time) (dt1+dt2+dt3) (p<0.001, A: median: 318.4±10.4 min, B: 246.56±8.28 min) and in caesarean section rates was noted (p<0.001, A: 89 vs B: 49). CONCLUSION The new type of partogram seems to have potential benefits such as reducing the incidence of prolonged labor and decreasing the caesarean section rates.
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Affiliation(s)
- Georgios Vlachos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Bachar Manav
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Grigorios Trypsianis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vasileios Liberis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sakellarios Karpathios
- Department of Obstetrics and Gynecology, Emeritus Assistant Professor, 1 University Alexandra Hospital, Athens, Greece
| | - Georgios Galazios
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
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Pergialiotis V, Vlachos D, Protopapas A, Chatzipapas I, Vlachos G. Review of the various laparoscopic techniques used in the treatment of bowel endometriosis. Minerva Ginecol 2015; 67:353-363. [PMID: 25424307] [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: 06/04/2023]
Abstract
Colorectal infiltration by endometriotic implants accounts about 90% of all intestinal location and is difficult to be assessed preoperatively by means of history taking and clinical examination. During the last decade, a number of studies are trying to assess various minimally invasive procedures in order to establish a therapeutic plan that is efficacious and produces acceptable clinical outcomes, preventing the morbidity that results from open surgery. The study aims to review the efficacy of these procedures as therapeutic options of endometriosis infiltrating the bowel. Thirty five observational studies were finally included in the present review involving 3490 women. Intraoperative complications were observed in 4.3% of women and postoperative complications in 7.8%. Quality of life was statistically significantly improved, wherever recorded. Postoperative pain reduction and fertility scores were also improved among cases that received either segmental resection or less radical operations. The various techniques described seem to be efficacious, with acceptable intraoperative and postoperative complication rates. Laparoscopic disc shaving or disc resection in cases of minimal bowel involvement seem to be sufficient alternatives to segmental bowel resection, resulting in high rates of fertilization.
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Affiliation(s)
- V Pergialiotis
- First Department of Obstetrics and Gynecology, Athens University, Medical School, Athens, Greece -
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Rodolakis A, Thomakos N, Koutroumpa I, Sotiropoulou M, Haidopoulos D, Vlachos G, Loutradis D. Abdominal radical trachelectomy for early stage cervical cancer: Fertility sparing approach. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.071] [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: 10/23/2022]
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Rodolakis A, Thomakos N, Vlachos G, Loutradis D. Radical abdominal trachelectomy during pregnancy for stage IB1 cervical carcinoma. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.031] [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: 10/23/2022]
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21
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Thomakos N, Koutroumpa I, Trachana S, Sotiropoulou M, Haidopoulos D, Papadimitriou C, Bamias A, Vlachos G, Rodolakis A. Significance of omentectomy during surgical staging for uterine serous carcinoma. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tranoulis A, Thomakos N, Haidopoulos D, Sotiropoulou M, Kathopoulis N, Davidovic-Grigoraki M, Papadimitriou C, Bamias A, Vlachos G, Rodolakis A. Accuracy of frozen section in the diagnosis of mucinous ovarian tumors. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.269] [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: 11/28/2022]
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23
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Hadjigeorgiou G, Dardiotis E, Tsivgoulis G, Doskas T, Petrou D, Makris N, Vlaikidis N, Thomaidis T, Kyritsis A, Fakas N, Treska X, Karageorgiou C, Sotirli S, Giannoulis C, Papadimitriou D, Mylonas I, Kouremenos E, Vlachos G, Georgiopoulos D, Mademtzoglou D, Vikelis M, Zintzaras E. Observational study assessing demographic, economic and clinical factors associated with access and utilization of health care services of patients with multiple sclerosis under treatment with interferon beta-1b (EXTAVIA). PLoS One 2014; 9:e113933. [PMID: 25419842 PMCID: PMC4242657 DOI: 10.1371/journal.pone.0113933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/03/2014] [Indexed: 11/18/2022] Open
Abstract
Multiple sclerosis (MS) results in an extensive use of the health care system, even within the first years of diagnosis. The effectiveness and accessibility of the health care system may affect patients' quality of life. The aim of the present study was to evaluate the health care resource use of MS patients under interferon beta-1b (EXTAVIA) treatment in Greece, the demographic or clinical factors that may affect this use and also patient satisfaction with the health care system. Structured interviews were conducted for data collection. In total, 204 patients (74.02% females, mean age (SD) 43.58 (11.42) years) were enrolled in the study. Analysis of the reported data revealed that during the previous year patients made extensive use of health services in particular neurologists (71.08% visited neurologists in public hospitals, 66.67% in private offices and 48.53% in insurance institutes) and physiotherapists. However, the majority of the patients (52.45%) chose as their treating doctor private practice neurologists, which may reflect accessibility barriers or low quality health services in the public health system. Patients seemed to be generally satisfied with the received health care, support and information on MS (84.81% were satisfied from the information provided to them). Patients' health status (as denoted by disease duration, disability status and hospitalization needs) and insurance institute were found to influence their visits to neurologists. Good adherence (up to 70.1%) to the study medication was reported. Patients' feedback on currently provided health services could direct these services towards the patients' expectations.
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Affiliation(s)
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | | | - Damianos Petrou
- Outpatient Clinic at Vostanio General Hospital of Mytilini, Mytilini, Greece
| | - Nikolaos Makris
- Neurology Department at Agios Andreas General University of Patra, Patra, Greece
| | - Nikolaos Vlaikidis
- 3rd University Neurology Department at Papanikolaou University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Thomas Thomaidis
- Neurology Department at Greek Red Cross Hospital, Athens, Greece
| | - Athanasios Kyritsis
- University Neurology Department at University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Fakas
- Neurology Department at 401 Military Hospital of Athens, Athens, Greece
| | - Xoulietta Treska
- 2nd University Neurology Department at AHEPA General University Hospital of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | - Ioannis Mylonas
- Outpatient Clinic at Interbalcan Medical Center, Thessaloniki, Greece
| | | | | | | | - Despoina Mademtzoglou
- BECRO, Pharmaceutical Services, Athens, Greece
- Department of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
| | - Michalis Vikelis
- Outpatient Clinic at Interbalcan Medical Center, Thessaloniki, Greece
- Medical Department, Novartis Hellas S.A.C.I., Athens, Greece
| | - Elias Zintzaras
- BECRO, Pharmaceutical Services, Athens, Greece
- Department of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
- The Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, MA, United States of America
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Thomakos N, Sotiropoulou M, Zacharakis D, Koutroumpa I, Valla E, Trachana S, Haidopoulos D, Zagouri F, Vlachos G, Rodolakis A. A new suggested pattern-based clinical classification system for endocervical adenocarcinoma. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.170] [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: 11/30/2022]
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Pergialiotis V, Vlachos D, Rodolakis A, Haidopoulos D, Christakis D, Vlachos G. Electrosurgical bipolar vessel sealing for vaginal hysterectomies. Arch Gynecol Obstet 2014; 290:215-22. [DOI: 10.1007/s00404-014-3238-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/28/2014] [Indexed: 11/29/2022]
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Galazios G, Tica V, Vrachnis N, Vlachos G, Zervoudis S, Ceausu I, Trypsianis G, Zographou C, Tsikouras P. Assessment of labor using a new type partogram compared to the classical Fisher partogram. J Matern Fetal Neonatal Med 2014; 28:82-7. [PMID: 24635455 DOI: 10.3109/14767058.2014.905908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/13/2022]
Abstract
OBJECTIVE To assess the quality of a new type partogram used to monitor labor. METHODS We compared efficacy using two types of partograms. The first was the classical WHO partogram (group A) and the second a new type in which we estimated and reported the sub of cervical dilatation and the position of the descending head (group B). RESULTS It was noted that there was a statistically significant decrease of the duration between the initiation of active phase of labor and the delivery time (dt1+dt2+dt3) (p<0.001, A: mean: 318.4±10.4 min, B: 246.56±8.28 min). Also observed was early initiation in the acceleration stage of the active phase in the first phase of labor (dt1) (p<0.001, A: 108.73±5.29 min, B: 69.96±4.99 min), shorter duration of the acceleration stage of the active phase in the first phase of labor (dt2) (p<0.001, A: 136.93±4.79 min, B: 91.89±4.04 min) and early initiation in the second phase of labor in women who were studied with the new partogram (B). CONCLUSION The new partogram is more helpful in the recognition of the initiation of the acceleration stage during the active phase of labor and in the timely use of appropriate actions in order to achieve a safer delivery.
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Affiliation(s)
- Georgios Galazios
- Department of Obstetrics and Gynecology, Democritus University of Thrace , Alexandroupolis , Greece
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Pergialiotis V, Vlachos D, Protopapas A, Pappa K, Vlachos G. Risk factors for severe perineal lacerations during childbirth. Int J Gynaecol Obstet 2014; 125:6-14. [DOI: 10.1016/j.ijgo.2013.09.034] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/19/2013] [Accepted: 12/30/2013] [Indexed: 11/26/2022]
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Skampardonis N, Thomakos N, Zacharakis D, Sotiropoulou M, Vlachos G, Haidopoulos D, Rodolakis A, Antsaklis A. Prognostic factors of recurrence in patients with advanced squamous cell carcinoma of the vulva treated with primary surgery and adjuvant radiotherapy: An institutional experience. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.458] [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: 11/30/2022]
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Thomakos N, Zacharakis D, Louradou D, Rodolakis A, Skampardonis N, Sotiropoulou M, Haidopoulos D, Vlachos G, Antsaklis A. Less radical surgery possible in patients with stage IB1 cervical cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rodolakis A, Thomakos N, Haidopoulos D, Vlachos G, Sotiropoulou M, Antsaklis A. Loupes assisted nerve-sparing abdominal radical trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.178] [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: 11/30/2022]
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Thomakos N, Rodolakis A, Zacharakis D, Valsamidis D, Stamatakis E, Anisiadou S, Haidopoulos D, Vlachos G, Antsaklis A. Need for high dependency units (HDUs) after gynecological oncology surgery. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.288] [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: 11/16/2022]
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Rodolakis A, Thomakos N, Vlachos G, Haidopoulos D, Sarris K, Sotiropoulou M, Papaspyrou I, Antsaklis A. Lymphadenectomy in apparent early-stage endometrial cancer – Clinical utility and cost effectiveness. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.368] [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: 12/01/2022]
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Vlachos G, Mousiolis AV, Protopapas A, Antsaklis A. A Case of Icodextrin 4% (Adept®) Induced Aseptic Peritonitis After a Cesarean Section and a Review of the Side-Effects of this Adhesion-Preventing Solution in Gynecologic Surgery. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2010.0084] [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)
- Georgios Vlachos
- First Department of Obstetrics and Gynecology, Alexandra University Hospital, Athens, Greece
| | - Athanasios V. Mousiolis
- First Department of Obstetrics and Gynecology, Alexandra University Hospital, Athens, Greece
| | - Athanasios Protopapas
- First Department of Obstetrics and Gynecology, Alexandra University Hospital, Athens, Greece
| | - Aris Antsaklis
- First Department of Obstetrics and Gynecology, Alexandra University Hospital, Athens, Greece
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Haidopoulos D, Simou M, Akrivos N, Rodolakis A, Vlachos G, Fotiou S, Sotiropoulou M, Thomakos N, Biliatis I, Protopappas A, Antsaklis A. Risk factors in women 40 years of age and younger with endometrial carcinoma. Acta Obstet Gynecol Scand 2010; 89:1326-30. [DOI: 10.3109/00016349.2010.515666] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Biliatis I, Haidopoulos D, Rodolakis A, Vlachos G, Protopapas A, Thomakos N, Sergentanis T, Akrivos N, Antsaklis A. Survival after secondary cytoreduction for recurrent ovarian cancer: Which are the prognostic factors? J Surg Oncol 2010; 102:671-5. [DOI: 10.1002/jso.21686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Xaidopoulos D, Biliatis I, Rodolakis A, Voulgaris Z, Vlachos G, Thomakos N, Antsaklis A. O126 The role of secondary cytoreductive surgery in the treatment of patients with recurrent ovarian cancer. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60498-7] [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: 11/15/2022]
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Biliatis I, Xaidopoulos D, Rodolakis A, Voulgaris Z, Vlachos G, Thomakos N, Protopapas A, Antsaklis A. O125 Papillary serous and clear cell carcinoma of the uterus: A single institution review of 111 cases. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60497-5] [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: 11/28/2022]
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Nicolaidis P, Vlachos G, Goumalatsos N, Tziortziotis D, Aravantinos D. Mixed malignant müllerian tumours: A study of 43 cases. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618809151380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Haidopoulos D, Voulgaris Z, Protopapas A, Rodolakis A, Vlachos G, Tsetsa P, Antsaklis A. Cervical intraepithelial neoplasia in young women. J OBSTET GYNAECOL 2009; 27:709-12. [DOI: 10.1080/01443610701612615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Papoutsis D, Belitsos P, Goumalatsos N, Vlachos G, Antsaklis A. CYSTIC CERVICAL ENDOMETRIOSIS: PRESENTATION OF AN UNUSUAL CASE. Maturitas 2009. [DOI: 10.1016/s0378-5122(09)70324-x] [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: 10/20/2022]
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Pafilis I, Haidopoulos D, Rodolakis A, Vlachos G, Voulgaris Z, Sotiropoulou M, Antsaklis A. Management of a pregnancy complicated by yolk sac tumor. Arch Gynecol Obstet 2009; 280:803-6. [DOI: 10.1007/s00404-009-0977-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
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Papadimitriou CA, Markaki S, Lianos E, Peitsidis P, Vourli G, Nikitas N, Vlachos G, Rodolakis A, Antsaklis A, Dimopoulos MA. Clinicopathological features of primary fallopian tube carcinoma: a single institution experience. EUR J GYNAECOL ONCOL 2009; 30:389-395. [PMID: 19761129] [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: 05/28/2023]
Abstract
PURPOSE OF INVESTIGATION Primary fallopian tube carcinoma (PFTC) is a rare malignancy with only few data existing on the impact of prognostic factors. METHODS We retrospectively analyzed 26 patients. Tissue blocks were reviewed and sections were stained for vascular endothelial growth factor (VEGF), matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), tissue inhibitors of metalloproteinases 1 and 2 (TIMP-1, TIMP-2), c-erbB-2, estrogen (ER), and progesterone receptors (PgR). RESULTS Reactivity for VEGF, ER, PgR, MMP-2, MMP-9, TIMP-1, TIMP-2 and c-erbB-2 was observed in 85%, 46%, 27%, 11.5%, 58%, 0%, 23% and 8% of specimens, respectively. None of the markers studied displayed prognostic significance. Regarding clinical prognostic factors, the hazard ratio (HR) for progression and death for patients with tumor residuum > 2 cm was 5.24 (p < 0.01) and 11.19 (p < 0.005), respectively. Patients with advanced stage disease had a HR of 12.55 (p < 0.05) for progression, while the HR for death was not found to be statistically significant. CONCLUSION None of the biomarkers studied seems to influence survival. Early-stage disease and optimal debulking are associated with improved outcome.
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Affiliation(s)
- C A Papadimitriou
- Department of Clinical Therapeutics, "Alexandra" Hospital, University of Athens School of Medicine, Greece.
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Stefanidis K, Loutradis D, Vassiliou LV, Anastasiadou V, Kiapekou E, Nikas V, Patris G, Vlachos G, Rodolakis A, Antsaklis A. Nevirapine induces growth arrest and premature senescence in human cervical carcinoma cells. Gynecol Oncol 2008; 111:344-9. [DOI: 10.1016/j.ygyno.2008.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 07/25/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022]
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Tsikouras P, Vlachos G. Gebutsüberwachung mittels Partogramme. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089255] [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: 10/18/2022] Open
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Grapsas X, Liberis V, Vassaras G, Tsikouras P, Vlachos G, Galazios G. Misoprostol and first trimester pregnancy termination. CLIN EXP OBSTET GYN 2008; 35:32-34. [PMID: 18390077] [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: 05/26/2023]
Abstract
OBJECTIVE To investigate the efficacy of vaginal administration of 800 microg misoprostol as a single dose without performing post expulsion systematic curettage in first trimester pregnancy termination. METHOD 113 women, aged 16-44, who requested first trimester pregnancy termination, received 800 microg of vaginal misoprostol. All examined women were divided into two groups depending on gestation age. The first group included of 67 women with up to nine weeks and the second of 46 with up to 12 weeks of pregnancy. RESULTS Abortion occurred within 24 hours and was completed in 74.3% of the cases. The mean induction-abortion interval was 5.9 +/- 1.7 hours (median 5.5 hours). Side-effects were experienced by 24 women (21.2%). There was no significant difference between groups in the success rate, induction-abortion interval, number of previous deliveries and side-effects. CONCLUSION Misoprostol is an effective agent for first trimester medical termination.
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Affiliation(s)
- X Grapsas
- Department of Obstetrics and Gynecology, Democritus University of Thrace, General Hospital of Alexandroupolis, Alexandroupolis, Greece
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Galazios G, Tsikouras P, Liberis V, Koutlaki N, Vlachos G, Teichmann AT, Maroulis G. Attitudes towards contraception in three different populations. CLIN EXP OBSTET GYN 2008; 35:22-26. [PMID: 18390075] [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: 05/26/2023]
Abstract
OBJECTIVE To investigate contraceptive behavior of women belonging to three different ethnic and/or socioeconomic populations as well as to evaluate the main sources of information concerning contraception in each population. METHODS 150 Muslim women living in Germany (group A), 120 Muslim women living in Thrace, Greece (group B) and 140 Christian Orthodox women living in Thrace, Greece were enrolled in the study. Attitudes concerning contraceptive practices were assessed by means of a questionnaire. Demographic and socioeconomic characteristics of each group were compared with the method of contraception used. Statistical analysis was performed using one-way analysis of variance (ANOVA), followed by Turkey's test, chi-square test and multiple logistic regression analysis. RESULTS The contraceptive pill (41.7%), the condom (35.1%), periodic abstinence (24.4%) and interrupted coitus were the most common methods of contraception. The gynecologist (23.4%), the family consultant (12.0%) and the sexual partner (10.2%) were the most usual sources of information. The use of contraceptive pills was more frequent among Muslims from Germany and Christians from Greece (p < 0.001), while the use of condoms was more frequent among Christians from Greece (p = 0.019). The use of IUDs was more frequent among Muslims from Germany and Greece (p = 0.039). CONCLUSIONS Our study results reveal that there are behavioral differences between race/ethnic groups and minorities regarding contraceptive practices, probably due to different cultural, socioeconomic and educational factors.
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Affiliation(s)
- G Galazios
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
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Papadimitriou C, Dafni U, Anagnostopoulos A, Vlachos G, Voulgaris Z, Rodolakis A, Aravantinos G, Bamias A, Bozas G, Kiosses E, Gourgoulis GM, Efstathiou E, Dimopoulos MA. High-dose melphalan and autologous stem cell transplantation as consolidation treatment in patients with chemosensitive ovarian cancer: results of a single-institution randomized trial. Bone Marrow Transplant 2007; 41:547-54. [PMID: 18026149 DOI: 10.1038/sj.bmt.1705925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of high-dose chemotherapy (HDCT) in epithelial ovarian cancer (EOC) remains controversial. This study was initiated to compare the efficacy and tolerability of HDCT as a consolidation approach in women with chemosensitive advanced EOC (FIGO stages IIC-IV). Patients who had achieved their first clinical complete remission after six cycles of conventional paclitaxel and carboplatin combination chemotherapy were randomly assigned to receive or not high-dose melphalan. The primary objective was to compare time to disease progression (TTP). A total of 80 patients were enrolled onto the trial. Patients who were randomized to receive HDCT were initially treated with cyclophosphamide 4 g/m(2) for PBPC mobilization. HDCT consisted of melphalan 200 mg/m(2). Of the 37 patients who were allocated to HDCT, 11 (29.7%) did not receive melphalan either due to patient refusal (n=5) or due to failure of PBPC mobilization (n=6). In an intent-to-treat analysis, there were no significant differences between the two arms in TTP (P=0.059) as well as in overall survival (OS) (P=0.38).
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Affiliation(s)
- C Papadimitriou
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens School of Medicine, Athens, Greece.
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Mantzaris G, Rodolakis A, Vlachos G, Athanasiou S, Theocharis S, Sotiripoulou CM, Antsaklis A. Magnifying lenses assisted nerve-sparing radical hysterectomy and prevention of nerve plexus trauma. Int J Gynecol Cancer 2007; 18:868-75. [PMID: 17892457 DOI: 10.1111/j.1525-1438.2007.01071.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The objectives of the study were to present a new approach for nerve-sparing radical hysterectomy (NSRH) with the assistance of magnifying lenses and to describe the differences in autonomic nerve plexus trauma between NSRH type III and conventional radical hysterectomy (RH) types II and III with the aid of immunohistochemistry. Eighteen women with FIGO stage IB(1)-IB(2) cervical cancer underwent loupes-assisted NSRH (n = 8), RH type II (n = 6), and RH type III (n = 4). Biopsies were taken intraoperatively from uterosacral ligament (USL) and cardinal ligament (CL), as well as from anterior vaginal wall (AVW) and posterior vaginal wall (PVW). Immunohistochemistry was approached with the use of S-100 protein, a general nerve marker. The percentage area of immunoreactivity (PAI) was used as an objective quantitative measure of nerve fibers within the ligaments. The PAI was greater in RH-III biopsies from both USL and CL (P < 0.001) when compared with RH-II and NSRH biopsies. For AVW and PVW, PAI differences were not statistically significant (AVW, P = 0.119; PVW, P = 0.067). Uterine-supporting ligaments represent a major pathway for autonomic nerves to the pelvic organs. As significantly more autonomic nerves are transected during the division of the uterine-supporting ligaments in RH type III, a more careful approach in the dissection of the ligaments through nerve-preserving techniques seems to be necessary in order to prevent iatrogenic intraoperative injury of the pelvic plexus and reduce or prevent postoperative complications.
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Affiliation(s)
- G Mantzaris
- 1st Department of Obstetrics and Gynecology, Gynecologic Oncology Unit and Urogynecology Unit, University of Athens, Alexandra Hospital, Athens, Greece.
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Haidopoulos D, Diakomanolis E, Rodolakis A, Voulgaris Z, Vlachos G, Intsaklis A. Can local application of imiquimod cream be an alternative mode of therapy for patients with high-grade intraepithelial lesions of the vagina? Int J Gynecol Cancer 2005; 15:898-902. [PMID: 16174242 DOI: 10.1111/j.1525-1438.2005.00152.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of the present study was to assess the local application of imiquimod cream 5% as an alternative mode of therapy for high-grade vaginal intraepithelial neoplasia (VAIN 2/3). Positive human papillomavirus (HPV) patients with multifocal high-grade VAIN (2/3) not involving the vaginal vault in hysterectomized patients took part in this study. The treatment consisted of vaginal application of the cream under colposcopic guidance. Following management, biopsies were obtained from the previously recorded lesions. p53 expression was recorded prior and after therapy. Seven patients with VAIN 2/3 took part in this study. Six patients (86%) were positive for high-risk HPV type while three (43%) women who were positive for p53 nuclei prior to therapy were found to be negative following treatment. After treatment, 86% of the patients were found to have either HPV infection or low-grade VAIN. During follow-up, two patients (28.5%) were managed by vaginectomy, one for persistent and one for recurrent high-grade VAIN. Currently, from the five patients that are followed, three have simple HPV infection and two, VAIN 1. Imiquimod cream 5% might represent an alternative although not permanent method of management in young, HPV-positive women with multifocal high-grade lesions of the vagina (VAIN 2/3).
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Affiliation(s)
- D Haidopoulos
- Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, University of Athens, Athens, Greece.
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