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We compared the skin compatibility of two menstrual pad technologies in a single-center, parallel, randomized, examiner-blinded study involving adult women. This report presents the results of a subset of 10 participants who had a genital infection within 12 months prior to the start of the study. In a blinded fashion, participants were randomized to receive one of the two pads for use over two menstrual periods. Participants’ skin erythema was graded 24-48 hours following cessation of menstrual flow and on day 14 of each menstrual cycle. Participants subjectively reported any sensory effects. Vulvar erythema scores for the mons pubis, labia majora, labia minora, perineum, buttocks, left medial thigh, and right medial thigh assessed after both menstrual cycles were not statistically different between groups or between the two different products. A low incidence of itching and burning occurred in both groups without statistical significance, none of the participants experienced a recurrent or new genital infection. These preliminary results show that participants with recent genital infections included in clinical studies do not exhibit greater valvar erythema or sensory effects than participants without recent genital infection. The study showed that the safety profile of the products tested remained acceptable in women with recent genital infection.

Polycystic ovary syndrome (PCOS) is a very common disorder affecting 5-10% of women of reproductive age. The pivotal endocrine abnormalities of this syndrome are insulin resistance and ovarian and, to a lesser degree, adrenal hypersensitivity to hormonal stimulation. PCOS may manifest itself as early as the first decade of life by premature pubarche or menarche. Oligoamenorrhea in the first postpubarchal years, although very common, may be an early symptom of PCOS, especially in overweight girls with hirsutism or acne. Girls with low birth weight as well as a family history of diabetes mellitus or premature cardiovascular disease are at high risk for developing PCOS. Circulating bioavailable testosterone levels are usually elevated, while total testosterone may be normal due to low levels of sex hormone-binding globulin. The typical sonographic appearance of PCOS ovaries consists of high ovarian volume (>10mL) and the presence of 12 or more follicles in each ovary measuring 2-9mm in diameter. However, this finding is not specific, since it may occur in >20% of healthy girls. The therapeutic goals in adolescents with PCOS is first to restore bodyweight and menses and to reduce the signs of hyperandrogenism. The reduction of bodyweight in this young age group may require the collaboration of the pediatrician, dietitian, and psychotherapist. The adolescent should be urged to adopt a healthy lifestyle with the aim to maintain a normal body mass index throughout adolescence and adult life. The choice of medical therapy depends on the clinical presentation. Oral contraceptives are a good option when acne and hirsutism are the principal complaints. Adolescents with isolated cycle irregularity may be placed on a cyclical progestin regimen to induce withdrawal bleeding. Metformin, by decreasing insulin resistance, alleviates many of the hormonal disturbances and restores menses in a considerable proportion of patients. It may be used alone or in combination with oral contraceptives. Independently of medical treatment, restoration and maintenance of bodyweight within normal range is of paramount importance. © 2006 Adis Data Information BV. All rights reserved.

Objective: To compare the effects of combined oral contraceptives (OCs) containing cyproterone acetate or desogestrel on insulin sensitivity in adolescents with polycystic ovary syndrome (PCOS). Design: A prospective randomized clinical trial. Setting: Outpatient gynecological clinic of Aretaieion University Hospital. Patient(s): Thirty-six adolescent girls with hyperandrogenism and six or less menses in the preceding 12 months. Intervention(s): Patients were separated in two groups: group A (n = 18) received 0.15 mg of desogestrel plus 0.030 mg of ethinyl E-2 daily; and group B (n = 18) received 2 mg of cyproterone acetate plus 0.035 mg of ethinyl E-2 daily, for 21 days followed by a 7-day rest, for 12 months. Main Outcome Measure(s): Hirsutism score, lipid, androgen, and sex hormone-binding globulin (SHBG) levels were evaluated at baseline. An oral glucose tolerance test (OGTT) was performed and metabolism indices, based on previously studied mathematical formulas, were assessed at baseline and at 12 months. Result(s): After 12 months of treatment, the homeostasis model assessment index of insulin resistance increased significantly in both groups. The fasting glucose-to-insulin ratio and predicted insulin sensitivity index decreased in group B. The delta of the area under the OGTT curve for insulin and predicted first and second phase insulin secretion indices increased significantly only in group B. Conclusion(s): We conclude that treatment of adolescent girls with PCOS with the two combined OCs administered, results in unfavorable changes of insulin sensitivity. In addition, cyproterone acetate is associated with an increase of insulin secretion and hyperinsulinemia.

Pathogenesis of endometriosis involves growth factors, which are synthesized locally. Insulin-like growth factor-1 (IGF-1) prevents apoptosis and has mitogenic action on endometrial cells. The IGF-1 gene undergoes alternative splicing and results in three isoforms (IGF-1Ea, IGF-1Eb, and IGF-1Ec or MGF). We analyzed the mRNA expression of IGF-1 isoforms in tissue samples of eutopic endometrium and endometriotic cyst obtained during laparoscopy from women with endometriosis. We documented that all three IGF-1 isoforms are expressed in both eutopic endometrium and ovarian endometrioma. Furthermore,we documented a significant decrease in all IGF-1 isoform expression in endometriotic cyst compared to endometrium of women with endometriosis. The reduction may correlate with the disease status and presence of fibrotic inactive tissue found in late stages of the disease. © 2006 New York Academy of Sciences.

Objective: To assess the improvement of obstetric and gynecologic training brought about by peer influence in Europe. Methods: In 1996, the European Board and College of Obstetrics and Gynecology (EBCOG) initiated a visiting process by international and local peers to improve training and decrease differences in health care standards. Results: A large number of visits of obstetrics and gynecology departments have been conducted across Europe at teaching hospitals by the Hospital Visiting Committee. Compliance with the structured approach of the visiting policy and problems met during these visits are reported. Conclusion: The program focuses on the continuous improvement of the competencies of all persons trained in the obstetrics and gynecology departments of teaching hospitals throughout Europe. It also increases the understanding of diversity in training methods and can gradually lead to the convergence of training and health care standards in Europe. (c) 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

OBJECTIVE: To determine during mid-trimester amniocentesis if elevated concentrations of ADAM-8 (A Disintegrin And Metalloprotease 8) and/or cortisol can recognize women at risk for spontaneous preterm delivery. METHODS: The study involved 312 women who underwent mid-trimester amniocentesis. Thirteen patients, who progressed to preterm delivery, were matched with 21 controls for age, parity, gestational age at amniocentesis, and year of amniocentesis. ADAM-8 and cortisol levels were measured by enzyme-linked immunosorbent assay and radioimmunoassay, respectively. RESULTS: ADAM-8 mean amniotic fluid concentrations were significantly higher in women with preterit delivery than in women delivering at term (mean 1213.9 [SE 96.7] pg/mL [range, 780 to 1854 pg/mL] vs mean 937.2 [SE 50.3] pg/mL [range, 486 to 1508 pg/mL], P < .02). Amniotic fluid ADAM-8 concentrations higher than 1149 pg/mL had the highest specificity and odds ratio (OR) in the identification of the women with increased risk for preterm delivery (sensitivity 61.5%; specificity 81.7%; OR, 9.6 [95% confidence interval (CI), 1.8 to 50.3]). Women with preterit delivery had suggestively higher amniotic fluid concentrations of cortisol (meant 1.3 [SE 0.2] mu g/dL [range, 0.4 to 2.2 mu g/dL]) than women delivering at term (meant 1.0 [SE 0.09] mu g/dL [range, 0.6 to 1.7 mu g/dL], P < .07). Furthermore, cortisol levels were positively correlated with ADAM-8 levels (Spearman’s r = .418, P < .014). CONCLUSIONS: Elevated paid-trimester amniotic fluid ADAM-8 concentrations possibly are a risk factor,for preterm delivery, particularly if ADAM-8 levels are greater than 1149 pg/mL. Potential intrauterine inflammation is also associated with suggestively increased amniotic fluid cortisol levels.

The aim of this study was to assess the association of endogenous sex steroids with bone mineral density (BMD) in healthy postmenopausal women not on hormone therapy. A total of 884 postmenopausal women aged 42-71 years were studied in a cross-sectional design. Parameters assessed were follicle-stimulating hormone, luteinizing hormone, estradiol, total testosterone, sex hormone-binding globulin, free estrogen index (FEI), free androgen index (FAI), Δ4-androstendione (Δ4A), dehydroepiandrosterone sulfate (DHEAS), bone alkaline posphatase, and bone mineral density at the lumbar spine (L-BMD) and femoral neck (N-BMD). Estradiol and FEI associated positively with both L-BMD and N-BMD (r = 0.21-0.47, P < 0.01). These associations remained significant after adjustment for age, years since menopause, and body mass index. FAI correlated positively with both L-BMD and N-BMD (r = 0.18 and 0.33, respectively; P < 0.01). At the multivariate analysis, however, FAI remained the significant determinant only for N-BMD. Δ4A associated positively with N-BMD (r = 0.27, P = 0.001), whereas DHEAS showed no association with BMD at either site. Thus, endogenous steroids are significant determinants of postmenopausal BMD. Endogenous estradiol may be more important for lumbar spine BMD, whereas endogenous androgens are associated mainly with femoral neck BMD. © Springer-Verlag Tokyo 2006.

The purpose of this study was to investigate the relationship between parity, maternal age at delivery, gestational age, and duration of the second stage of labor. In this article a retrospective analysis of deliveries during the period from 2000 to 2005 in our Institution was made. We recorded 208 pregnant women under the age of 20 years , 6,115 between 20 and 40 years, and 188 over the age of 40 years considering parity, duration of second stage of labor, birth weight, and gestation age. The correlation of the above parameters was statistically analyzed. In primigravidas, under the age of 20 years, the second stage of labor was significantly shorter compared to women aged over 40 years, and significantly shorter compared to women between the age of 20 and 40 years. Gestational age at delivery was significantly shorter in women aged over 40 years compared to those under the age of 20 years as well as to those between 20 and 40 years of age. Age was positively correlated to the duration of the second stage of labor and negatively correlated to the gestation age at delivery. In multigravidas, age was negatively correlated to the gestational age at delivery. In primigravidas, maternal age was positively correlated with the duration of the second stage of labor. On the contrary, gestational age at delivery was negatively correlated with maternal age. In multigravidas, a negative correlation between maternal age and gestational age at delivery was statistically significant. © 2006 New York Academy of Sciences.

Objectives: To evaluate and compare the effect of different than classical hormone therapy medications, such as raloxifene and tibolone, on the uterine arteries and endometrium of postmenopausal women using transvaginal ultrasonography. Methods: The prospective study included 62 healthy, postmenopausal women recruited from the Menopausal Clinic of the 2nd Department of Obstetrics and Gynecology of the University of Athens. Subjects were randomly allocated to receive raloxifene HCl in a daily dose of 60 mg orally (Group A-31 women) or tibolone in a daily dose of 2.5 mg orally (Group B-31 women). The study period was 6 months and all subjects were assessed using transvaginal ultrasonography before treatment initiation as well as after 3 and 6 months for evaluation of the endometrial thickness and the pulsatility (PI) and resistance (RI) indices at the level of the uterine arteries. Results: No significant differences in RI, PI and endometrial thickness were observed in the raloxifene group during the 6-month treatment. In the tibolone group, PI and RI values decreased linearly from baseline to the end of the study, whereas the endometrial thickness was significantly increased during the first 3 months remaining unaltered thereafter. Comparisons between the two study groups revealed significant percent change of values in the pre-treatment to month-3 period and no difference with regard to pre-treatment, month-3 and month-6 absolute values. Conclusion: Raloxifene and tibolone exert dissimilar effects on uterine blood supply parameters and endometrial thickness. © 2005 Elsevier Ireland Ltd. All rights reserved.

The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first-trimester pregnancies complicated by threatened abortion (TACP) and its relevance to obstetric outcome. Serum levels of Th1-type cytokines interleukin-1β (IL-1β), tumor necrosis factor alpha (TNF-alpha), and Th2-type cytokine interleukin 6 (IL-6) were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A) and compared with the corresponding levels of 31 gestational age-matched women with TACP and successful outcome at admission (group B1) and discharge (group B2) and 22 gestational age-matched women with first-trimester uncomplicated pregnancy (group C) who served as controls. Mann-Whitney U or Wilcoxon test was applied as appropriate to compare differences between groups. IL-1β and TNF-alpha were detected with significantly higher levels in group A, compared to all other groups. On the contrary, IL-6 levels were detected with no significant difference among all the other groups studied. It is concluded that in first-trimester TACP with adverse outcome, a distinct immune response, as reflected by elevated maternal IL-1β, TNF-alpha, and unaltered IL-6 levels, is relevant to a negative obstetric outcome. Copyright © 2006 Nicolaos Vitoratos et al.

Exogenous advanced glycation endproducts (AGEs, known atherogenic molecules) abundant in everyday precooked, rich in fat, overheated meals can possibly contribute to the increased risk for diabetes and cardiovascular disease in women with polycystic ovary syndrome (PCOS). The aim of the present study was to investigate the effect of a lipase inhibitor on absorbed food glycotoxins in healthy women and those with PCOS. A 2-day protocol was followed. In the first day, a meal rich in AGE was provided, which on the second day was followed by two 120-mg capsules of lipase inhibitor, orlistat. Serum AGE levels were evaluated at baseline (0 hours), and at 3 and 5 hours postmeal during the study. Thirty-six women were Studied, 15 controls (mean age, 28.80 +/- 5.47 years; body mass index, 25.85 +/- 6.73 kg/m(2)) and 21 with PCOS (mean age, 25.29 +/- 5.06 years; body mass index, 30.40 +/- 7.51 kg/m(2)) (University Hospital, Athens, Greece, institutional practice). Serum AGE levels, on day 1, were significantly increased both in the control group and in the PCOS group as compared with basal values (control group, 14.1%; PCOS group, 6.0%; P

Objective. To determine whether the computerized analysis of fetal heart rate variability with the new matching pursuit technique can indicate fetal distress during labor. Study design. Eighty women were studied during the intrapartum period with external cardiotocography. In all cases, cord arterial pH and 5-min Apgar Scores were evaluated. Six cases that presented large segments of missing data were excluded from the study. The remaining 74 women were divided into two groups; 32 women with normal ( Group A) and 42 women with non-reassuring FHR tracings ( group B). Group B was divided in subgroup BI, including 24 women with pH >7.20, and BII, including 18 women with pH

The objective of the study was to evaluate the efficacy and safety of 800 jig of misoprostol every 12 h, for a period of 36 h for pharmacological abortion. A group of 162 volunteer women with gestations between 50 and 63 days received misoprostol every 12 h up to a maximum of three doses for abortion. Outcome measures assessed included: successful abortion (complete abortion without requiring surgery), side effects, and a decrease in hemoglobin, mean time of vaginal bleeding, mean expulsion tin-le and mean time of returning of menses. Complete abortion occurred in 148 of 162 (91%, 95% confidence interval 87.95) patients. The mean decrease in hemoglobin was statisticaly significant (p = 0.001). Vaginal bleeding lasted 8.0 +/- 3.2 days, spotting 8.0 +/- 3.5 days, and total bleeding 16 +/- 4.0 days. The mean expulsion time was 8.5 +/- 4.0 h. According to the observed outcomes, 800 mu g of misoprostol vaginally could be a valid method to terminate pregnancies up to 9 weeks of gestation.

HLA-G antigens are highly expressed in maternal peripheral blood during early pregnancy in transgenic mice. In this study, we determined the levels of HLA-G in white blood cells during early pregnancy and after interruption of pregnancy in triple transgenic mice (H-2K(b)/HLA-G, h beta 2m, and hCD2/hCD8-TRI). The pregnancies were interrupted on day 7 using the anti-progesterone agent millepristone (RU486). Blood samples of 20 pregnant TRI mice were taken and the HLA-G levels were determined on days 2, 4 and 6 of pregnancy and on days 9, 11 and 13 after fertilization. The monoclonal antibody W6.32, specific for monomorphic determinant HLA class I molecules, was used in combination with an immunolocalization method Using it photonic microscope, The HLA-G levels increased gradually on days 2, 4. and 6 of pregnancy, and the interruption of pregnancy on day 7 was followed by it decrease of FILA-G levels. The data indicate that pregnancy is characterized by the early), presence of HLA-G in maternal peripheral blood in TRI transgenic mice and suggest that HLA-G may serve as it useful indicator for pregnancy maintenance and well-being. (c) 2005 International Federation for Cell Biology. Published by Elsevier Ltd. All rights reserved.

Menopause-related oestrogen deficiency increases the risk of cardiovascular disease (CVD). The presence of abdominal obesity, dyslipidemia, hypertension, fasting hyperglycaemia or impaired glucose tolerance further aggravates the CVD risk imposed by menopause. A detailed personal history should be recorded, covering PCOS, gestational diabetes mellitus, alcohol intake and smoking, as well as a family history of cardiovascular disease. Screening of the a-symptomatic post-menopausal woman should include fasting lipid profile, plasma glucose and liver, renal and thyroid function tests. Serum low-density lipoprotein cholesterol (LDL-c) > 130 mg/dL is associated with an increased risk of CVD. Levels of triglycerides (TG) ≥ 150 mg/dL and high-density lipoprotein cholesterol (HDL-c) ≤ 50 mg/dL coupled with an increase in small dense LDL and very low-density lipoprotein (VLDL) particles constitute the atherogenic dyslipidemia, which characterizes the metabolic syndrome. In women with previous VTE episodes, screening for thrombophilia is advisable, as well as an estimation of baseline homocysteine and C-reactive protein (CRP). Non-pharmacological intervention should be targeted towards smoking cessation, a low-salt, low-fat, high-fibre diet and increased physical activity. © 2005 Elsevier Ireland Ltd. All rights reserved.

Objective: To evaluate the effect of sperm treatment with exogenous platelet-activating factor (PAF) on IUI clinical pregnancy rate. Design: Prospective randomized study. Setting: Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Subject(s): Fifty-two couples with unexplained infertility, candidates for IUI. Intervention(s): Sperm treatment with an exogenous mixture of PAF (final concentration, 10(-7) mol/L) in sperm-washing medium, direct swim-up technique of sperm preparation, a maximum of six IUI cycles per couple with or without PAF treatment. Main Outcome Measure(s): Clinical pregnancy rate (pregnancies confirmed by ultrasonography per hundred cycles). Result(s): The overall clinical pregnancy rate after a maximum of six IUI cycles was significantly higher when sperm was treated with PAF compared with the rate after the direct swim-up technique (23.07% vs. 7.92%). Conclusion(s): Treatment of sperm with exogenous PAF might improve the clinical outcome of IUI in cases of unexplained infertility. (c) 2005 by American Society for Reproductive Medicine.

To investigate in prepubertal obese children (POC) the profile of chronic low-grade systemic inflammation (CLGSI) and its relation to homocysteinemia, 72 POC were evaluated for serum C-reactive protein (CRP) and amyloid A (SAA) levels, both markers of CLGSI, and plasma levels of total homocysteine (tHcy), an independent risk factor for adult atherosclerosis, in comparison to 42 prepubertal lean children (PLC). The main observations in POC were higher CRP levels compared to PLC, positive association of SAA levels to CRP levels, no association of CRP or SAA levels to tHcy levels. Thus, in POC, positively interrelated to each other, elevated CRP and unaltered SAA levels reveal a unique profile of the CLGSI, not explaining homocysteinemia-induced risk for future atherosclerosis. © 2005 Hindawi Publishing Corporation.

The skin compatibility of a new surface covering for feminine hygiene pads was assessed by 1) skin irritation patch tests, 2) the Human Repeat Insult Patch Test, and 3) a test protocol for assessing mechanical irritation that uses repeated application to the popliteal fossa ("behind-the-knee" test). The pad covering is a fabric-like apertured film with a soft and supple tactile impression. Testing was designed to assess the effects of topical contact as well as friction. All studies showed the new material to be as mild as other commercially available materials used on the surface of feminine hygiene pads. Induction of delayed contact hypersensitivity was not found. The test methods used can be applied to the safety assessment of other products that involve topical skin contact and frictional effects. Copyright © Taylor & Francis Inc.

Objective. To investigate the possible link between insulin resistance and preeclampsia. Methods. The study included 30 primigravidas between 28 and 34 weeks of gestation. The study subjects were divided into two groups: Group A consisted of 15 normotensive women of a mean gestational age of 31.6 weeks and group B consisted of 15 preeclamptic women of a mean gestational age of 29.9 weeks. Glucose and insulin levels were measured at 0, 1 and 2 h of an OGTT (after 75 g oral glucose administration). Insulin resistance and sensitivity were evaluated with the use of IR HOMA, QUICKI and IS OGTT. Results. Glucose and insulin levels at 0, 1 and 2 h of the OGTT as well as IR HOMA, QUICKI and IS OGTT were comparable between preeclamptic and normotensive pregnant women. Conclusions. Our results indicate that preeclampsia is not associated with hyperinsulinaemia and/or insulin resistance, in either the fasting or the postprandial state.

Background: Cytokines play an important rote during tabor and full- or preterm delivery. They influence physical immunity of the fetus-neonate and express a leading rote in the perinatal period, being present in maternal and fetal tissues. Aim: To investigate whether cytokine concentrations in the mother, fetus and neonate depend on the tabor and the mode of the delivery. Study design: Prospective study. Subjects: Seventy-eight healthy, non-smoking parturients (mean age 28 4, range 21-39 years, delivering vaginally: n=52 or by elective cesarean section: n=26) and their single, healthy, appropriate for gestational age, full-term neonates. Outcome measures: We correlated determined circulating levels of IL-2, sIL-2R, IL-4, sIL-4R, IL-6, sIL-6R, IL-1 beta, IL-8, IFN-gamma, TNF-alpha, sTNF RI, sTNF RII and RANTES in the mothers before delivery (MS), the fetuses (UC) and the neonates in days 1 (N1) and 4 (N4) of life, with the mode of delivery. Results: sIL-2R in N1 and N4, sIL-4R in MS, IL-6 in MS and UC, IL-1 beta in MS, UC and N1, IFN-gamma in MS and UC, TNF-alpha in UC, N1 and N4, sTNF RI in UC were significantly higher in cases of vaginal delivery than in cases of elective cesarean section (p ranging from 0.0005 to 0.05). Conclusions: Vaginal delivery promotes the production of various cytokines and their receptors, which are implicated in neonatal immunity. (c) 2004 Elsevier Ireland Ltd. All rights reserved.

Objective: To describe a unique case of descending salpingitis and functioning endometrium in a noncavitated müllerian remnant in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Design: Case report. Setting: Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Patient(s): A 25-year-old patient with MRKH syndrome who presented with lower abdominal pain. Intervention(s): Clinical examination, transabdominal ultrasonography, laparoscopy, laparotomy. Main Outcome Measure(s): Clinical symptoms of salpingitis and hematometra; laparoscopic and laboratory confirmation. Result(s): Laparoscopy revealed an infection of the right salpinx, and surgical excision by laparotomy revealed a noncanalized müllerian remnant with functioning endometrium. Conclusion(s): Salpingitis can present in patients with MRKH syndrome. Probable presence of functioning endometrium must be taken under consideration. ©2005 by American Society for Reproductive Medicine.

Background: Cutaneous and sensory effects of sanitary pads with a novel “fabric-like” polyethylene film surface (topsheet) were assessed. Methods: Cutaneous erythema and subjective sensory effects of a test pad with fabric-like film topsheet ( group size: 53) and a commercial pad with a conventional nonwoven fabric topsheet ( group size: 55) were compared in a randomized, examiner-blind, prospective trial lasting two menstrual cycles. Only the assigned pads were used menstrually. An assigned panty liner brand was worn intermenstrually at participant discretion. Primary outcome measures were 1) the frequency and severity of erythema of the vulva, perineum, buttocks, and upper thighs, as visually scored by using a standard scale postmenstrually ( 16 - 84 hours after flow cessation) and intermenstrually ( days 12 - 16); 2) sensory irritation frequency as reported on daily diaries; and 3) product preference ratings. Results: The frequency and severity of erythema did not differ between groups except for cycle 2, when a statistically higher mean erythema score ( in the barely perceptible range) occurred postmenstrually on the right thigh ( commercial pad group) and intermenstrually on the buttocks ( test pad group). The frequency of rubbing, itching, or burning sensations declined from about 2% after cycle 1 to less than 1% after cycle 2, with no consistent difference between groups. The test pad was preferred overall, especially for absorbency and soiling protection. Conclusions: The test pad was well tolerated and comparable in skin compatibility to a commercial pad with a history of acceptable use.

The angiogenic factors vascular endothelial growth factor (VEGF) and placenta growth factor (PlGF) are respectively up- and downregulated by hypoxia. We aimed to study circulating levels of the above factors in intrauterine growth restriction (IUGR) and to correlate their levels with the customized centiles of the infants. The study included 25 IUGR and 25 appropriate for gestational age (AGA) full-term, singleton infants and their mothers. Maternal (MS), fetal (UC), and neonatal day 1 (N1) and 4 (N4) blood was examined. MS and N1 PlGF, as well as UC VEGF levels correlated with the customized centiles of the infants (r = 0.39, P = .007, r = 0.34, P = .01, and r = -0.41, P = .004, resp). Furthermore, UC, N1, and N4 VEGF levels were higher in girls (r = 0.36, P = .01, r = 0.33, P = .02, and r = 0.41, P = .005 resp). In conclusion, positive and negative correlations of examined factors with the customized centiles of the infant could rely on placental function and intrauterine oxygen concentrations-both being usually lower in IUGR cases-while higher VEGF levels in girls should possibly be attributed to the stimulating action of estrogens. © 2005 Hindawi Publishing Corporation.

Aim: Aim of the study was to investigate the efficacy of single transvaginal ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy with concurrent review of the literature. Materials and methods: Six patients with cervical pregnancy are included in the study. All patients were treated with single transvaginal ultrasound-guided intraamniotic installation of 70 mg of methotrexate plus folic acid p.o. The main presenting symptoms were mild to moderate vaginal bleeding and lower abdominal cramp-like pain, resembling the clinical presentation of a threatened abortion. The typical ultrasound findings were the absence of intrauterine gestational sac and the detection of a gestational sac within the cervical canal, invading the anterior or the posterior wall of the cervix and normal appearance of the adnexa, bilaterally. The hourglass-shaped cervix was not characteristic at 5 weeks of gestation but it was at 8 weeks of gestation. Discussion: Ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy appears to be an effective and safe method but the choice of the method should be depended on the gestational age of cervical pregnancy, the presence of active bleeding or not and its severity, the desire for preservation of future fertility, the presence of coexisting valuable intrauterine pregnancy and the experience of the physician in charge. © Springer-Verlag 2004.

Objective: To assess endogenous androgen and insulin resistance status in postmenopausal women receiving continuous combined hormone therapy (HT), tibolone, raloxifene or no therapy. Methods: A total of 427 postmenopausal women aged 42-71 years were studied in a cross-sectional design. Among them 84 were taking HT (46 women conjugated equine estrogens 0.625 mg; medroxyprogesterone acetate, 5 mg, CEE/MPA; and 38 women 17 beta-estradiol 2 mg: norethisterone acetate 1 mg, E2/NETA); 83 were taking tibolone 2.5 mg; 50 were taking raloxifene HCl 60 mg: and 210 women were not receiving any therapy. Main outcome measures were FSH, LH estradiol, total testosterone, SHBG, free androgen index (FAI), Delta(4)-Androstendione (Delta(4)-A), Dehydroepiandrosterone sulphate (DHEAS) and HOMA insulin resistance index (HOMA-IR). Results: In women not on hormone therapy smoking and older age was associated with lower DHEAS levels. FAI values increased linearly with increasing BMI. Age and BMI were positive determinants of HOMA-IR, while no association was identified between endogenous sex steroids and insulin resistance. CEE/MPA therapy was associated with higher SHBG, lower FAI and lower HOMA-IR values compared to women not on therapy (age and BMI-adjusted SHBG: CEE/MPA 148.8 nmol/l, controls 58.7 nmol/l, p < 0.01 age-adjusted FAI: CEE/MPA 0.8, controls 3.2,p < 0.05; age-adjusted HOMA-IR: CEE/MPA 1.3, controls 2.6, p < 0.05). On the contrary, E2/NETA treatment had no effect on these parameters. Women on tibolone had lower SHBG. higher FAI and similar HOMA-IR values compared to controls (age and BMI-adjusted SHBG: 24.1 nmol/l, p < 0.01; FAI: 6.0. p < 0.05: HOMA-IR: 2.3, p = NS). Raloxifene users did not exhibit any difference with respect to sex steroids and HOMA-IR levels. Conclusions: CEE/MPA users had lower free testosterone and improved insulin sensitivity. Tibolone on the other hand associated with higher free testosterone, while raloxifene did not relate to any of these parameters. (c) 2004 Elsevier Ireland Ltd. All rights reserved.

Objective: To present a new imaging technique for the evaluation of the functional effectiveness of Creatsas vaginoptasty. Method: Eighteen women with Mayer-Rokitansky-Kuster-Hauser syndrome underwent a transabdominal and transperineal ultrasound examination 4 weeks and 6 months after the surgical creation of a neovagina, and then yearty, with a condom filled with water as a distending and imaging medium. The functional length and width of the neovagina and its axis deviation were assessed, as well as the postoperative quality of the women’s sexual life. Results: A functional vagina 10 to 12 cm in length and 4 to 5 cm in width was observed; its axis deviation, which was similar to the anatomic deviation, was easily determined; and 94.5% of the women reported a satisfactory white 5.5% reported an adequate sexual life. Conclusion: This new imaging technique is a simple and effective alternative for the evaluation of the postoperative effectiveness of colpopoiesis. (c) 2005 International. Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Objective Women with polycystic ovary syndrome (PCOS) carry a number of cardiovascular risk factors and are considered to be at increased risk for atherosclerosis. Elevated concentrations of advanced glycation end-products (AGE), which exert their effects through interaction with specific receptors (RAGE), have been implicated in the cellular and tissue damage during atherosclerotic processes. Design/patients We investigated serum AGE levels in 29 young women with PCOS as well as the expression of their receptor, RAGE, in circulating monocytes and compared them levels with 22 healthy control women. Measurements/results Women with PCOS had higher levels of serum AGE proteins compared to healthy individuals (9.81 +/- 0.16 vs. 5.11 +/- 0.16, P < 0.0001), and increased RAGE expression was observed in monocytes of PCOS women compared to controls (30.91 +/- 10.11 vs. 7.97 +/- 2.61, P < 0.02). A positive correlation was observed between AGE proteins and testosterone (T) levels (r = 0.73, P < 0.0001). The correlation between AGE proteins and T levels remained high (partial correlation coefficient = 0.61, P = 0.0001) after controlling for body mass index (BMI), insulin levels and the area under the curve for glucose (AUCGLU) during an oral glucose tolerance test (OGTT). A positive correlation was also observed between AGE proteins and the free androgen index (FAI) (r = 0.58, P < 0.0001), waist-to-hip ratio (WHR) (r = 0.31, P < 0.02), insulin (r = 0.46, P < 0.001), homeostasis model assessment (HOMA) (r = 0.47, P < 0.0001), AUCGLU (r = 0.52, P < 0.002) and RAGE (r = 0.59, P < 0.01). A negative correlation was observed between AGE proteins and glucose/insulin ratio (GLU/INS) (r = -0.35, P < 0.01), and the quantitative insulin sensitivity check index (QUICKI) (r =-0.50, P < 0.01). In multiple regression analysis T was the only independent predictor of AGE levels (P < 0.0001, b = 0.044) between BMI, insulin, SHBG and AUCGLU (adjusted R-2 = 0.59, F = 44.41, P < 0.0001). Conclusion These data clearly demonstrate, for the first time, that PCOS women without overt hyperglycaemia have increased AGE levels and elevated RAGE expression when compared with controls.

STUDY OBJECTIVE: To identify the prevalence of patients with BMI extremes (BMI>88% or < 2%) in our Adolescent Gynecology clinic and audit their weight management. DESIGN: Retrospective case series. SETTING: The Adolescent Gynecology Clinic of a British District General Hospital PARTICIPANTS: All patients aged 12-17 years when first seen in the Adolescent Gynecology clinic from 1997 to 2003. INTERVENTIONS: Retrospective data collection on biometry and weight management interventions. MAIN OUTCOME MEASURES: The percentage of obese (BMI>98(th) percentile for age), overweight (BMI 88(th)-98(th) percentile) and underweight (BMI < 2(nd) percentile) based on published percentile BMI curves for the UK adolescent population, the proportion of patients with extreme BMI that were offered intervention, the types of intervention offered, the proportion of patients whose BMI improved after the intervention, and the number of patients with BMI>88% among smokers were compared to non-smokers. RESULTS: Of the 125 patients 24% were obese, an additional 17% overweight and 1% underweight. The expected figures in the general population are 2%, 10% and 2% respectively (P < 0.001; test of a single proportion). Weight management intervention was offered to 47% of patients with extreme BMI. The BMI improved in 36% of the patients who were offered and 14% of patients who were not offered intervention (P=0.066; chi(2)). There was no statistically significant difference between smokers and non-smokers in the proportion of patients with BMI>88% (P=0.93; chi(2)). CONCLUSION: There is significantly increased prevalence of obese and overweight women among adolescent gynecological patients. The need for management of the BMI of these patients has not been always been recognized and treatment is not particularly effective. The results indicate a need for defined strategies and additional resources for obesity management. J Pediatr Adolesc Gynecol

Objectives: To review the main findings of the Euralox 1 study - a multicentre, randomised, double-blind study conducted in 1008 healthy postmenopausal women allocated to raloxifene (n = 495) or continuous combined estrogen-progestin therapy (ccEPT; n = 513) for 6 months - and provide an overview of the risks and benefits of raloxifene and ccEPT. Methods: A review is provided of previously published findings on uterine safety (bleeding rates and changes in endometrial thickness and uterine volume), gynaecological adjudication, cardiovascular risk (lipids, fibrinogen), adverse events, compliance, treatment satisfaction and quality of life. New data on biochemical markers of bone turnover (serum N-telopeptides and C-terminal telopeptides of type I collagen; NTX and CTX) assessed before and after 6 months' treatment are presented. Results: Raloxifene caused less uterine bleeding than ccEPT and, unlike ccEPT, did not alter endometrial thickness or uterine volume. Serum CTX and NTX levels were reduced in both treatment groups, but the reduction was significantly greater with ccEPT. The two treatments had differential effects on lipids and fibrinogen levels; raloxifene had more favourable effects on serum HDL, the LDL/HDL ratio, and plasma fibrinogen. Raloxifene was associated with fewer adverse events or discontinuations, and this was associated with higher treatment satisfaction and better self-reported compliance. Conclusions: The clinical risk-benefit profile of raloxifene derived from the intermediate endpoints of this study suggests that it may be a better alternative to ccEPT for preventing long-term postmenopausal health risks in healthy postmenopausal women who are not suffering from vasomotor symptoms. © 2005 Elsevier Ireland Ltd. All rights reserved.

During menopause women tend to gain body fat. The increase in adiposity seems to be a consequence of the decline in endogenous estrogens and the reduced energy expenditure. The role of post-menopausal hormone replacement therapy (pHT) in modulating visceral obesity is controversial. Some studies have shown that pHT has no effect on body weight while in other studies pHT increased body weight. Leptin is an adipocyte-derived hormone and its levels reflect the amount of adipose tissue. Obesity is associated with elevated serum leptin levels. The effect of pHT on leptin levels is also controversial. In some studies pHT increased leptin levels while other studies have not confirmed this increasing effect. The major problem encountered during administration of hormone therapy seems to be the timing of pHT initiation which is a strong confounder on the effect of pHT on leptin levels in postmenopausal women.

Study Objective: To identify the prevalence of patients with BMI extremes (BMI > 88% or < 2%) in our Adolescent Gynecology clinic and audit their weight management. Design: Retrospective case series. Setting: The Adolescent Gynecology Clinic of a British District General Hospital. Participants: All patients aged 12-17 years when first seen in the Adolescent Gynecology clinic from 1997 to 2003. Interventions: Retrospective data collection on biometry and weight management interventions. Main Outcome Measures: The percentage of obese (BMI > 98th percentile for age), overweight (BMI 88 th-98th percentile) and underweight (BMI < 2 nd percentile) based on published percentile BMI curves for the UK adolescent population, the proportion of patients with extreme BMI that were offered intervention, the types of intervention offered, the proportion of patients whose BMI improved after the intervention, and the number of patients with BMI > 88% among smokers were compared to non-smokers. Results: Of the 125 patients 24% were obese, an additional 17% overweight and 1% underweight. The expected figures in the general population are 2%, 10% and 2% respectively (P < 0.001; test of a single proportion). Weight management intervention was offered to 47% of patients with extreme BMI. The BMI improved in 36% of the patients who were offered and 14% of patients who were not offered intervention (P = 0.066; χ2). There was no statistically significant difference between smokers and non-smokers in the proportion of patients with BMI > 88% (P = 0.93; χ2). Conclusion: There is significantly increased prevalence of obese and overweight women among adolescent gynecological patients. The need for management of the BMI of these patients has not been always been recognized and treatment is not particularly effective. The results indicate a need for defined strategies and additional resources for obesity management. © 2005 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.

One thousand six hundred forty-one IUI cycles performed in 615 couples were categorized, depending on the semen analysis of the male partner, in three groups of normozoospermia, teratozoospermia, and male factor infertility. Clinical pregnancies and live births per cycle were significantly decreased in the teratozoospermia,group when compared to the normozoospermia group, with the exception of the first IUI attempt (comparable outcomes), whereas the cumulative live birth rate after four IUI attempts was significantly lower in the teratozoospermia and male factor infertility groups. (c) 2005 by American Society for Reproductive Medicine.

Aim: The aim of this study was to determine the effects of vacuum extractor assisted delivery on fetal oxygenation and acid-base balance. Methods: Sixty-one women were enrolled in the present study. The subjects were divided into two groups. Group A, consisting of 39 women, had normal vaginal deliveries. Group B, consisting of 22 women, underwent a vacuum extractor assisted vaginal delivery. Fetal arterial oxygen saturation (SpO2) monitoring was used in all women after full cervical dilatation. After delivery, umbilical artery pH, pCO2, pO2 and base deficit (BDecf) levels were determined in all neonates. Results: The mean FSpO2 value in Group A was 51.53±5.87% and in Group B 48.03±6.39% (p

The aim of the study was to assess the effect of continuous hormone therapy (HT) for 1 yr on pulse wave analysis and central aortic pressure in healthy postmenopausal women. Sixty-five healthy postmenopausal women were randomly allocated to receive either conjugated equine estrogens 0.625 ring plus medroxyprogesterone acetate 5 mg (CEE/MPA, Premelle 5, Wyeth - Ayerst Lab, Philadelphia, PA, no.=32) or no therapy (no.=33). Treatment was continuous, and the study period lasted 12 months. Central aortic pressure, augmentation and augmentation index (AI) were determined non-invasively using applanation tonometry. All measurements were performed at baseline and at the end of the study by the same person. Ns differences were found between baseline values and values at the end of the study in either the control or the CEE/MPA group in central systolic aortic pressure (107.0 +/- 13.1 vs 107.6 +/- 11.3 mmHg, p=0.80, and 110.8 +/- 10.8 vs 112.3 +/- 11.4 mmHg, p=0.23, respectively), augmentation (112.6 +/- 4.2 vs 11.9 +/- 4.8 mmHg, p=0.45 and 11.7 +/- 3.7 vs 12.6 +/- 4.2 mmHg, p=0.34, respectively), and percentage of AI (36.8 +/- 9.3 vs 36.3 +/- 10.3, p=0.81 and 34.1 +/- 8.9 vs 34.9 +/- 9.8, p=0.72, respectively). The results of this preliminary report suggest that HT for 1 yr does not have any significant effect on central aortic pressure and wave reflection in healthy postmenopausal women. (c) 2005, Editrice Kurtis.

Aim: The aim of the study was to investigate the type of pregnancy loss (PL) in women with recurrent miscarriages. Materials and methods: The study population included 411 women with a history of recurrent pregnancy loss (RPL) attending the Recurrent Miscarriage Clinic of the 2nd Department of Obstetrics and Gynecology, University of Athens (tertiary referral center). Subjects were divided in groups according to their underlying pathology and in some of them appropriate treatment was applied. Results: The study of the 323 pregnancies achieved after referral, revealed that the PL after ultrasonographic detection of fetal heart (FH) is overall increased, is more common in women with anatomical uterine anomalies and unexplained RPL, and treatment reduces its rate in women with anatomical uterine anomalies and an inadequate luteal phase. The PL before the detection of FH is reduced after treatment in women with thrombotic tendency and an inadequate luteal phase. © Springer-Verlag 2004.

Objective: To describe two cases of leiomyoma development in patients with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH syndrome). Design: Case report. Setting: Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. Patient(s): A 42-year-old woman with MRKH syndrome presented with lower abdominal pain, and a 38-year-old woman with MRKH syndrome presented with an asymptomatic left adnexal mass. Interventions(s): Clinical examination, transabdominal ultrasonography, IV urography, laparoscopy. Main Outcome Measure(s): Ultrasound. Result(s): In both cases, laparoscopy revealed a leiomyoma originating from the left uterine remnant. The leiomyomas and the adjacent uterine remnants were laparoscopically excised. Conclusion(s): In rare cases, leiomyomas can originate from the fibromuscular tissue of uterine remnants in patients with MRKH syndrome.

Objective: To evaluate the effect of continuous combined hormone therapy (HT), tibolone and raloxifene on circulating vascular endothelial growth factor (VEGF) in postmenopausal women. Design: One-year prospective intervention study. Methods: One hundred and forty-six postmenopausal women with a mean age of 51.8+/-1-4.1. (S.D.) years received 0.62 5 mg conjugated equine estrogen (CEE) plus 5 mg medroxyprogesterone acetate (MPA) (CEE/MPA, n = 34), 2.5 mg tibolone (n = 3 7), 60 mg raloxifene (n = 40) or no active treatment (control group. n = 35). Plasma VEGF was estimated at baseline and at 6 and 12 months. Results: In both the CEE/MPA-treated and the tibolone-treated groups plasma VEGF increased significantly at month 6 and remained elevated at month 12 (CEE/MPA baseline: 268.1 +/- 187.8 pg/ml, month 6: 320.0 +/- 175.3 pg/ml, month 12: 321.1 +/- 181.8 pg/ml, P = 0.01: tibolone baseline: 240.6 +/- 165.8 pg/ml, month 6: 271.4 +/- 172.7 pg/ml, month 12: 274.8 +/- 183.1 pg/ml, P = 0.03). These changes were significantly different from the respective changes in the control group after adjusting for T-score in bone densitometry (CEE/MPA: P = 0.02, tibolone: P = 0.04). The effect of HT or tibolone on plasma VEGF was mainly evident in women with low baseline VEGF levels (< 243.2 pg/ml, median for whole sample). On the contrary, VEGF levels in the raloxifene-treated or the control group did not change throughout the study. Conclusion: Both continuous combined HT and tibolone increased circulating VEGF in postmenopausal women. while raloxifene had no effect. Further research is needed to clarify the clinical relevance of these findings with respect to cardiovascular risk in postmenopausal women.

Diabetes insipidus (DI) is a rare complication of pregnancy. In cases related to pregnancy, the condition is thought to result from enhanced placental clearance of arginine vasopressin secondary to placental vasopressinase production. In such cases careful monitoring of the patient's fluid balance during and after pregnancy is essential. If treatment is necessary, desmopressin is the drug of choice. In the present article, we present three cases of pregnancy complicated by DI.

Objective(s): Aim of the study was to assess the effectiveness and the complications associated with the use of tension-free vaginal tape (TVT) in women with stress urinary incontinence and low urethral closure pressure (LUCP). Study design: Thirty-seven patients with stress urinary incontinence and LUCP who were treated with the TVT procedure have been included in the study. Physical examination and urodynamic investigations were carried out to all women preoperatively and at 6, 12 and 26 months (average, range: 22-30 months), postoperatively. The mean age of the patients was 69 years ( 13), while mean parity was 2.2 (range 0-3). Results: TVT procedure was carried out in all patients with epidural anesthesia. Postoperative evaluation showed 27 patients (73%) to have been completely cured, four (9.25%) to have a considerable improvement, whereas six patients (16.2%) were classified as failures. Only a few complications occurred. Conclusion(s): Our study indicates that the TVT procedure is an effective and well-accepted minimal invasive surgery for treatment of urinary stress incontinence in women with LUCP. The cure rate of 73% could be considered satisfactory. Women with LUCP and ‘fixed’ urethra, are at significantly increased risk of failure of the procedure. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

This study investigated in prepubertal obese children (POC), compared with prepubertal lean children (PLC), a possible relation among plasma total homocysteine (tHcy)-an independent risk factor for future atherosclerosis-and MCP-1 and RANTES, two circulating chemokines inducing leukocyte transendothelial migration (TEM), implicated in the initial stages of the inflammatory part of the atherosclerotic process. Seventy-two POC were evaluated for circulating tHcy, MCP-1, and RANTES, and compared with 42 healthy PLC. The mean adjusted (for age, sex as well as log10total insulin, vitB12, folate, total cholesterol, HDL cholesterol, log10triglycerides, and log 10glucose levels) differences in tHcy, MCP-1, and RANTES levels between PLC and POC were all significant [1.16 nmol/mL (P = 0.03), 26.6 pg/mL (P = 0.02), and 52.9 pg/mL (P = 0.03), respectively]. In PLC, but not in POC, tHcy levels were negatively associated with both circulating MCP-1 (B = -1.68, P = 0.007) and RANTES (B = -1.16, P = 0.01) after adjusting for age, sex, BMI, as well as log10total insulin, vitB12, folate, total cholesterol, HDL cholesterol, log10triglycerides, and log10glucose levels. In conclusion, in POC there is a lack, in contrast to PLC, of a possibly autoregulatory, negative association of elevated tHcy levels to increased MCP-1 and RANTES levels. This could contribute to future, homocysteine-induced atherosclerosis.

Objective: To analyze the expression of transforming growth factor (TGF)β1 in human uterine leiomyomas and adjacent myometrium obtained at hysterectomy of women at mid/late follicular phase (n = 15), at mid/late luteal phase (n = 12) and after sex steroid ablation therapy. Materials and methods: Sex steroid ablation therapy was carried out using luteinizing-hormone-releasing hormone analog (triptorelin 3.75 mg intramuscularly every 28 days for at least 3 months; n = 10) and postmenopause (n = 8). The expression of TGFβ1 mRNA was analyzed by northern blots and in situ hybridization analysis while the immunohistochemical analysis assessed TGFβ1 expression at protein levels. In addition, we tested the time- and dose-dependent effects of TGFβ1 (0.5-50 ng/ml; final concentration; 24 and 48 h) on the proliferation (cell number, trypan blue exclusion) of KW smooth muscle-like myometrial cells in vitro. Results: Our data demonstrated that TGFβ1 (mRNA and protein) expression was higher in leiomyomas at mid/late follicular phase compared with those at luteal phase and to adjacent myometrium at either phases of the menstrual cycle. However, TGFβ1 expression (mRNA and protein) did not differ significantly among leiomyomas at luteal phase, leiomyomas after luteinizing-hormone-releasing hormone analog therapy, myometrium at follicular phase, myometrium at luteal phase and myometrium postmenopause. Conclusion: We conclude that TGFβ1 may be an important autocrine/paracrine factor in human leiomyomas particularly during the mid/late follicular phase. © 2004 Future Drugs Ltd.

Objective: Good reproductive health depends to a great extent on how well informed people are on contraception issues. Contrary to the situation existing in many European countries, in Greece there has been a lack of studies investigating how well informed Greek women and men are. Also, the sources on which they draw are equally important. The aim of this study was to examine the knowledge of Greek women and men on issues of contraception, with the ultimate goal of identifying which groups should be the focus of prevention planning programs. Method: A country-wide survey was conducted through a self-administered questionnaire. The sample, numbering 1500 people, was representative of the Greek population aged 16-45 years. Results: A key finding was that only a small percentage of the respondents were able to answer correctly 50% or more of the questions on knowledge of basic contraceptive issues (30.6% of women and 14.7% of men). Regarding sources of information, media and friends were reported as the primary sources of information for men of all ages and young women. The gynecologist becomes a significant source of consultation for women only after the age of 25 years. Even then, only 4% of women visiting a gynecologist do so to obtain information on prevention of pregnancy. The majority of women asking professional advice have already experienced an unwanted pregnancy. Conclusion: The need for health education is apparent, especially for young people.

This retrospective study was undertaken to assess the epidemiological and clinical features, laboratory findings, preoperative work-tip, surgical treatment and pathologic findings in adolescents with ovarian cysts. All adolescents who were referred to our institution and had been operated on because of a diagnosed ovarian mass, from January 1997 to June 2003, were included in this study. Forty-four cases of women with an ovarian mass were retrospectively analyzed. These patients, aged between 12 and 21 years, had 47 ovarian masses (three patients had bilateral lesions), of which 49% were non-neoplastic and 51% were neoplastic. Of the neoplastic lesions, 62.5% were germ cell tumors, 20.8% were epithelial and 16.7% were sex cord-stromal tumors. Of the neoplastic tumors, 95.8% were benign while 4.2% were malignant. Procedures included 30 operative laparoscopies (68.2%) and 14 exploratory laparotomies (31.8%). Simple excision of the ovarian cyst was performed in 39 cases (88.6%). According to our study, most of the adolescents with an ovarian cyst underwent an operation because of a neoplastic lesion. The majority of ovarian tumors occurring in adolescents are non-epithelial in origin, and germ cell tumors are the most common histological type. Ultrasound examination is one of the most important diagnostic tools. Preoperative diagnostic approach of these patients should always include careful history taking, physical examination, imaging and evaluation of serum assays. Gynecologists who care for young girls must be familiar with the differential diagnosis of ovarian masses whose surgical treatment should be conservative when appropriate, so that hormonal status and future fertility are not compromised in this group of patients.

Objective(s): To investigate whether the quantity of collagen types I and III in the pubocervical fascia of women with genuine stress incontinence (GSI) affects the efficacy of the tension-free vaginal tape (TVT) procedure. Methods: Sixty-three patients participated in the study and were divided in 2 groups as follows: 37 patients with GSI and pelvic organ prolapse stage I ( group 1), and 26 patients with pelvic organ prolapse stage I but not GSI ( control group). Urodynamic studies confirmed the diagnosis of GSI. Biopsies were obtained during surgery from the pubocervical fascia. Results: The quantity of collagen types I and III was statistically significantly reduced in patients with GSI compared to the control group. The efficacy of the TVT procedure in patients with a significant reduction in collagen type I was an 82.1% cure. In patients with a significant reduction in collagen type III, the TVT efficacy was an 85.1% cure. The efficacy of the TVT procedure was not statistically significantly different between patients with GSI and a significant reduction in collagen types I and III, and patients with no reduction in collagen types I and III. Conclusions: The significantly reduced quantity of collagen types I and III in the pubocervical fascia of women with GSI does not affect the efficacy of the TVT procedure at an average of 25 months of follow-up. Copyright (C) 2004 S. Karger AG, Basel.

Objective: To investigate the effect of continuous combined hormone therapy and raloxifene on serum VE-cadherin. Design: The study was double blinded, with a placebo run-in period of 28-50 days. Setting: University menopause clinic. Patient(s): Twenty-eight healthy postmenopausal women devoid of climacteric complaints. Intervention(s): Subjects were randomized to 17beta-estradiol (2 mg) + norethisterone acetate (1 mg; E-2-NETA) or raloxifene hCL (60 mg) for a period of 6 months. Main Outcome Measure(s): Serum VE-cadherin, which was estimated at baseline and at month 6. Result(s): Serum VE-cadherin decreased significantly in both E-2-NETA and raloxifene groups (raloxifene baseline +/- SD: 1.17 +/- 0.44 ng/mL, 6 months: 0.82 +/- 0.29 ng/mL; E-2-NETA baseline: 1.19 +/- 0.47 ng/mL, 6 months: 0.92 +/- 0.49 ng/mL). Percentage changes from baseline were -21.7 +/- 24.3 for E-2-NETA and -26.0 +/- 20.6 for raloxifene. Conclusion(s): The effect of E-2-NETA and raloxifene suggests that these drugs may preserve interendothelial junction integrity and control vascular permeability. Although this effect may influence the progress of the atheromatous lesion, its clinical impact on coronary artery disease (CAD) remains uncertain. (C) 2004 by American Society for Reproductive Medicine.

The aim of the study was to examine changes in the levels of mRNA for procollagen type I and III in women with or without genuine stress incontinence (GSI). The study was performed in the 2nd Department of Obstetrics and Gynecology of University of Athens. Sixty-eight women participated in the study and they were divided in two groups. We did not find statistically significant difference between the two groups of patients in relation to the amount of mRNA of procollagen type I and III (p>0.05), but the quantity of collagen type I and III was significantly reduced in patients with stress incontinence (p

Insulin levels, insulin resistance, and leptin levels were evaluated in 47 women who developed ovarian hyperstimulation syndrome (OHSS) after participation in assisted reproduction technologies programs and in 47 matched controls who did not develop such a complication. Analysis of the results in relation to underlying polycystic ovarian syndrome and hyperinsulinemia revealed no association of insulin levels, insulin resistance, and leptin levels with the development of OHSS.

Objectives: The study objectives were to explore current contraceptive behavior of Greek women during reproductive age. Study design: Data were drawn from a country-wide survey, conducted with the use of a self-administered questionnaire. The sample, numbering 797 women of ages 16-45 years, was representative of the Greek female population of reproductive age. Results: The most common contraceptive method reported was the male condom (MC) (33.9%) followed by coitus interruptus (CI) (28.8%), oral pill (4.8%), and coil (3.6%). Other methods counted for a 5% and no use of contraception reached a 23.8%. Attitudes over responsibility of using contraception were also explored. The majority of respondents (52%) stated that contraception use is the responsibility of men. The probability of reporting that women should be responsible in using contraception was higher in women aged 25-34 years, in those with higher level of knowledge over contraception issues and in those with an experience of abortion. Conclusions: The need for sexual education and easy access to counseling services is apparent in order to promote optimal contraception decision-making. The role of women in taking active responsibility over contraception use should be of great importance in reproductive health promotion projects. (C) 2004 Elsevier Ireland Ltd. All rights reserved.