Search

Pubic symphysis diastasis in pregnancy is a rare obstetric complication. A case of a 35 year old primigravid woman with severe pubic symphysis diastasis and sacroiliac joint relaxation during non-operative vaginal delivery is reported and the literature reviewed. The patient was successfully treated by open reduction and internal fixation with plate and screws. During a 5 year follow-up, the patient presented with no pain and complete recovery to pre-injury functional level. Early diagnosis and immediate intervention by pelvic stabilization and in severe cases surgical intervention are the key points for the management of pubic symphyis diastasis, which optimize the maternal outcome.

Εισαγωγή/Σκοπός: Τα ενδοκυττάρια μονοπάτια σηματοδότησης Akt/mTOR και ΜΑΡΚ ενεργοποιούνται συχνά σε διάφορους τύπους καρκίνου, αλλά τα μέχρι τώρα δεδομένα στην διεθνή βιβλιογραφία για τον καρκίνο του ενδομητρίου είναι περιορισμένα. Ο σκοπός της παρούσας μελέτης ήταν να διερευνηθεί η κλινική σημασία της έκφρασης των φωσφορυλιωμένων βιοδεικτών p-ΜΑΡΚ, p-Akt και p-mTOR σε σχέση με τα κλινικο-παθολογοανατομικά χαρακτηριστικά των καρκινωμάτων και την πρόγνωση των ασθενών με τύπου Ι καρκίνωμα του ενδομητρίου.Υλικό-Μέθοδος: 103 ασθενείς με τύπο I καρκίνωμα του ενδομητρίου, που υποβλήθηκαν σε χειρουργική επέμβαση στην Γυναικολογική Κλινική του Πανεπιστημίου Πατρών το χρονικό διάστημα από το 1995 έως το 2010, με διαθέσιμους κύβους παραφίνης, μελετήθηκαν αναδρομικά με ανοσοϊστοχημεία για την έκφραση των φωσφορυλιωμένων βιοδεικτών p-ΜΑΡΚ, p-Akt και p-mTOR. Η έκφραση των ίδιων βιοδεικτών μελετήθηκε επίσης σε μη νεοπλασματικό ενδομητρικό ιστό.Αποτελέσματα: Η ανοσοϊστοχημική έκφραση των φωσφορυλιωμένων βιοδεικτών διαφέρουν μεταξύ δειγμάτων από καρκινώματα του ενδομητρίου και μη νεοπλασματικού ενδομητρικού ιστού. Η έκφραση της p-Akt παρατηρήθηκε αποκλειστικά σε καρκινώματα του ενδομητρίου. Η έκφραση της p-MAPK ήταν υψηλότερη σε καρκινώματα του ενδομητρίου σε σύγκριση με τον μη νεοπλασματικό ενδομητρικό ιστό (p

Necrotizing fasciitis is a rare, life-threatening surgical infection in pregnancy with high rates of morbidity and mortality. A 15-year-old primigravid woman, at 28 weeks of gestation with no significant previous medical history, was admitted to our hospital complaining of severe left lower extremity pain and high fever the last 72 hours. During clinical examination, she had a swollen, erythematous and tender to palpation inflamed skin over the medial aspect of the upper thigh without any evidence of injury. Incision drainage was performed immediately and she received broad spectrum antibiotics. During initial laboratory examinations, diabetes mellitus was diagnosed. There was no clinical improvement over the following days. Magnetic resonance imaging (MRI) revealed subcutaneous tissue inflammation and edema of infected tissues confirming the disease entity. Multidisciplinary therapy with immediate aggressive surgical debridement of necrotic tissues, multiple antibiotics, and intensive care monitoring was performed successfully. The patient’s postoperative course was uncomplicated and skin defect was closed with split thickness skin grafting. Our case emphasized the potential immunosuppressive role of pregnancy state in conjunction with diabetes mellitus in the development of severe necrotizing soft tissue infections.

Introduction. Malignant transformation of sex-steroid dependent tissues is associated with the loss of expression of sex steroid receptors as well as of the tumor suppression gene p53. The aim of this study is to evaluate the expression of sex-steroid receptors, p53 and Ki-67 in specimens from pre-malignant and malignant cervical epithelial lesions throughout the menstrual cycle. Material and Methods. Immunohistochemical staining was performed on formalin fixed, paraffin embedded tissue sections of normal squamous cervical epithelium, cervical intraepithelial neoplasia and invasive squamous cervical carcinoma, specimens utilizing antibodies against estrogen receptors, progesterone receptors, p53 protein and Ki-67 antigen. Results. In the samples taken from the normal cervical tissue, basal cells were usually estrogen receptor-positive, progesterone receptornegative, p53-negative and Ki-67-negative throughout the menstrual cycle. In contrast, para-basal cells were estrogen receptorpositive and progesterone receptor-negative in the follicular phase, but estrogen receptor-negative and progesterone receptor -positive and Ki-67 positive in the luteal phase. In cervical precancerous and cancer tissue samples (cervical intraepithelial neoplasia and squamous cervical carcinoma), the expression of estrogen receptors decreased. 31.15% of cervical intraepithelial neoplasia and 11.5% of squamous cervical carcinoma were positive for estrogen receptors. However, the expression of progesterone receptors increased. 29.5% of cervical intraepithelial neoplasia and 49.2% of squamous cervical carcinoma were positive for progesterone receptors. Positive staining for p53 was observed in 15 (24.59%) cases of cervical intraepithelial neoplasia and in 39 (64%) of squamous cervical carcinoma. The expression Ki-67 index in squamous cervical carcinoma cases (47.60%) was significantly higher than of cervical intraepithelial neoplasia cases (30.2%) (p=0.041). Conclusion. The findings of this study suggest that tumor cervical cells evade normal growth control by sex steroid hormones while synchronously abnormal regulatory mechanisms acquire control of the cell cycle.

We report a rare case of spontaneous uterine rupture of an unscarred uterus caused by adenomyosis in the early third trimester. A 33-year-old primigravid woman was referred to our department because of severe acute abdominal pain and signs and symptoms of hemorrhagic shock. Ultrasound exanimation performed at admission revealed a living, intrauterine fetus of 28 weeks gestational age with reduced amniotic fluid and presence of free peritoneal fluid. The fetal heart rate was non-reassuring with variable decelerations and severe fetal bradycardia. Emergency cesarean section revealed massive hemoperitoneum and complete rupture in the uterine fundus. Subtotal peripartum hysterectomy with conservation of adnexae was performed. Histological examination revealed adenomyosis at the site of uterine rupture.

The Akt/mTOR and MAPK pathways are frequently activated in various tumor types but data on endometrial carcinoma are limited. The aim of the present study was to investigate the clinical significance of the expression of phosphorylated MAPK, Akt and mTOR (p-MAPK, p-Akt, p-mTOR) in type I endometrial carcinoma.The study comprised of 103 formalin-fixed paraffin-embedded (FFPE) type I endometrial carcino ma cases, retrospectively retrieved and assessed by immuno histochemistry for p-MAPK, p-Akt and p-mTOR expression. The expression of these proteins was also studied in non-neoplastic endometrial tissue adjacent to the tumor.The expression patterns of these molecules differed between malignant and non-tumorous tissue specimens. The immuno reactivity for p-Akt was exclusively detected in the neoplastic tissues. Expression levels of p-MAPK were higher in tumors compared to non-neoplastic endometrium (p0.001), while p-mTOR was found to be over-expressed in non-neo plastic endometrium compared to carcinomas (p=0.001). Expression of p-Akt was correlated with p-MAPK protein levels (p=0.022, r=0.229). On the other hand, no association was found with clinicopathological parameters and with disease-free (DFS) or overall survival (OS) of the patients.Our findings support the de-regulation of the PI3K/Akt/mTOR and MAPK signaling pathways in type I endometrial carcinomas suggesting involvement of these pivotal pathways in endometrial carcinogenesis.

Aim: In our study we evaluate the diagnostic and therapeutic efficacy of transvaginal ultrasound guided aspiration of benign ovarian cysts in selected patients. Methods: Between January 2005 and June 2008, 46 women with persistent ovarian cyst (more than 6 months) were referred to the Outpatient Clinic of the Department of Obstetrics and Gynecology of the University of Patras Medical School. All procedures were performed in an outpatient basis. For the procedure we used an ultrasound unit with a 5 MHz transvaginal probe. The aspirated fluid was collected and sent for cytological analysis. All women were reevaluated at 1, 3 and 6 months after the procedure. Comparisons between groups were performed by Pearson’s chi-square test and two tailed Fischer exact test. Statistical analyses were performed by the Statistical Package for Social Sciences for Windows (SPSS-17). Results: The frequency of serous ovarian cysts was 73.9% (n=34), of serous-hemorrhagic cysts 8.69% (n=4) and of endometriotic cysts was 17.5% (n=8). The cytological analysis was negative in all cases. Our study showed an overall recurrence rate for ovarian cysts of 39.1%. Women with endometriotic ovarian cysts have an increased incidence of recurrence 62.5% (n=5), in comparison to serous cysts 35.2% (n=12) and serous-hemorrhagic cysts 15% (n=1), X2=9.913, df=2, p=0.007. Conclusions: The results of our study reveal that transvaginal ultrasound guided aspiration of persistent benign ovarian cysts is a simple, safe and effective procedure.

Previous studies have shown that elevated preoperative serum CA 125 levels strongly correlate with various clinical and pathological variables and prognosis of patients with endometrial carcinoma (EC). The aim of the present study was to evaluate the clinical significance of preoperative serum CA 125 levels in patients with EC.A retrospective study of all EC patients treated at our institution between 1995 and 2010 with available follow-up was conducted. The preoperative serum level of CA 125 was measured in 99 patients and evaluated in relation to various clinical and pathological variables and outcome. We used the cut-off level of 20 U/ml for CA 125 on chi-square test for categorical variables. Survival analysis was performed with the use of Kaplan Meier method, the log rank test and Cox proportional hazards regression analysis.In the early stages of disease the mean values of CA 125 were 35 U/ml (SD±70) for stages IA-IB and 21 U/ml (SD±29) for stage IC (Mann-Whitney test for continuous variables). In advanced stages of disease (III-IV), the values of preoperative serum CA 125 levels were statistically increased, with mean value 54 U/ml (SD±44), in comparison to stages IA-IB (p=0.02) and IC (p=0.007). According to the multivariate analysis, elevated preoperative serum CA 125 level (p=0.043) and histological tumor type (p=0.004) were independent prognostic factors for disease free survival (DFS) and overall survival (OS) of patients with EC.The current study suggests that measurement of preoperative serum CA 125 is a useful clinical tool in the prognosis of patients with EC.

A 66-year-old woman was referred to our hospital for the management of recurrent ovarian adenocarcinoma. Eight years earlier, she presented with a mass in the left ovary without ascites, which was ...

Objective: Plasma cortisol in obese subjects does not differ from that in normoweight subjects. Extra-adrenal cortisol production by 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) can result in local hypercortisolemia. The aim of the present study was to examine the role of visceral hypercortisolemia in the development of metabolic syndrome in severe obesity. Methods: Eight lean women during hysterectomy (controls) and 19 severely obese women during bariatric surgery were studied, 8 without metabolic syndrome (OM– group) and 11 with it (OM+ group). Biopsies of omental and subcutaneous fat were performed in the severely obese women during surgery, but only omental biopsies in the controls. Expression of 11β-HSD1, glucocorticoid receptor α (GRα) and glucocorticoid receptor β (GRβ) was evaluated using real-time PCR.Results: Omental 11β-HSD1 expression was different between groups (one-way ANOVA, p < 0.01). Post-hoc analysis revealed that mean omental 11β-HSD1 mRNA levels were higher in the OM– group compared to controls, whereas they were similar when comparing the OM+ group with lean controls. Expression of 11β-HSD1 in subcutaneous fat was not different between OM+ and OM– groups. GRα expression in omental fat did not differ among groups or between omental and subcutaneous fat in severely obese patients. An expression of GRβ was not detected.Conclusion: Contrary to our original hypothesis, omental 11β-HSD1 expression is not increased in the OM+ group.

Patients with heart failure often present with impaired renal function, which is a predictor of poor outcome. The cardiorenal syndrome is the worsening of renal function, which is accelerated by worsening of heart failure or acute decompensated heart failure. Although it is a frequent clinical entity due to the improved survival of heart failure patients, still its pathophysiology is not well understood, and thus its therapeutic approach remains controversial and sometimes ineffective. Established therapeutic strategies, such as diuretics and inotropes, are often associated with resistance and limited clinical success. That leads to an increasing concern about novel options, such as the use of vasopressin antagonists, adenosine A1 receptor antagonists, and renal-protective dopamine. Initial clinical trials have shown quite encouraging results in some heart failure subpopulations but have failed to demonstrate a clear beneficial role of these agents. On the other hand, ultrafiltration appears to be a more promising therapeutic procedure that will improve volume regulation, while preserving renal and cardiac function. Further clinical studies are required in order to determine their net effect on renal function and potential cardiovascular outcomes. Until then, management of the cardiorenal syndrome remains quite empirical.