Breast implant – Associated Anaplastic large cell lymphoma

Breast Implant –Associated Anaplastic Large Cell Lymphoma is a newly recognized malignant neoplasm presenting in breasts of women who have had breast implants for cosmetic or reconstructive purposes. A review of the literature showed thatit is an uncommon, slow growing T-cell lymphoma with morphology and immunophenotype similar to anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma. Its clinicopathologic features and treatment, however, are unique. It usually follows an indolent clinical course, but it has the potential to form a mass, to invade locally through the periimplant breast capsule into the breast parenchyma or soft tissues and/or to spread to regional lymph nodes. Surgical removal of the implant en bloc with the whole of the capsule (explantation plus complete capsulectomy) is the treatment of choice and confers an excellent disease free and overall survival. In the few cases with metastatic disease, chemotherapy is used as an adjuvant therapy. Early detection and management convey the best prognosis; therefore clinicians, gynecologists among others, ought to be aware of this new entity and refer suspicious cases for further evaluation and treatment. Change in attitudes towards implant based surgery does not seem necessary, as long as patients are properly informed about the risk of breast implant –associated anaplastic large cell lymphoma.

Perioperative fluid management-Goal Directed Therapy (GDT)

Perioperative goal-directed hemodynamic therapy is a protocolized treatment strategy aimed at optimization of global cardiovascular dynamics, including oxygen delivery to tissues and organ perfusion pressure. This is achieved by titrating fluids, vasopressors, and inotropes to predefined physiological target values of hemodynamic variables. Its scope is to reduce complications (acute kidney disease, pulmonary oedema, respiratory distress syndrome, wound infections), decrease major abdominal and systemic postoperative complications, length of stay and postoperative morbidity and mortality mainly in high-risk patients undergoing major surgery. Identifying patients in whom perioperative goal-directed hemodynamic therapy can actually improve postoperative outcomes is crucial. This is a review focusing on all the aspects of GDFT compared to standard fluid therapy during surgery.

Toxoplasmosis, a rare case report that led to a successful pregnancy

A 19-year-old female patient was presented to our clinic for a pregnancy follow-up during which primary toxoplasmosis infection was diagnosed. The patient was successfully treated with spiramycin and finally delivered normally a healthy boy, on term. Serological tests (ELISA) for detection of anti-toxoplasma antibodies along with ultrasonography findings on the fetus are the gold standard for the diagnosis. Spiramycin was used for embryo protection to avoid T.gondii transmission to the fetus across the placenta.

Deep vein thrombosis in pregnancy

Venous thrombotic events (VTE) prevalence is estimated to be 1-2 for every 10,000 pregnancies, making it one of main causes of maternal mortality in developed countries. VTE’s leading risk factors are history of the condition and hereditary thrombophilia. D-dimer tests conducted during pregnancies have in many cases led to false positive results while a few false negatives have also been found. For pregnant women, it is important for evaluation to begin with compression ultrasound before magnetic resonance imaging, which seeks a negative test and focuses on the pelvis. On the other hand, a chest x-ray should be done for pulmonary embolism, which helps in deciding between a CT pulmonary angiogram and perfusion study for normal and abnormal x-ray, respectively. Generally, treatment is composed of heparin of low molecular weight for at least six weeks after childbirth. Thrombolysis can be significant for life-threatening and serious thrombolysis. For populations at high risk, VTE prophylaxis still faces a lot of uncertainty. In fact, there is still little evidence to support the essence of mechanical prophylaxis for all women who have delivered through cesarean.

Ovarian hyperstimulation syndrome and the risk of internal jugular vein thrombosis

Introduction: Thromboembolic events are a rare complication of severe ovarian hyperstimulation syndrome (OHSS). In contrast to the classical left ilio-femoral deep vein thrombosis casesduring pregnancy,atypical localization in upper extremity, including internal jugular vein (IJV)is also reported. Review of the literature: We reviewed 39 cases of IJV thrombosis associated with OHSS mostly during assisted reproductive treatment. The diagnosis was made during first trimester, mainly with Doppler ultrasound, and treatment with heparin was initiated in all cases. In 14 patients another risk factor for thromboembolic event was reported (50% had FV-Leiden mutation). The IJV was extended in upper extremityincluding axillary, subclavian or superior vena cava in 46%, whereas pulmonary embolism was reported in 10% of cases. Discussion: Obstetricians should be aware of the rare complication of deep vein thrombosis in upper extremity including thrombosis of IJV, even weeks after OHSS symptoms have resolved.Patients with OHSS after assisted reproductive treatmentshould be prescribed heparin in prophylactic dose during the first trimester.

Relationship of soluble Fms-like tyrosine kinase 1, soluble endoglin, placental growth factor blood levels with the severity of late onset preeclampsia

Purpose: Preeclampsia (PE) is a pregnancy-specific syndrome characterized by placentation disorder that increases maternal and fetal morbidity and mortality. Overproduction of anti-angiogenic factors such as soluble fms-like tyrosine kinase receptor 1 (sFlt-1) and soluble endoglin (sEng) and low production of placental growth factor (Pgf) from angiogenic factors contribute to preeclampsia pathogenesis. In this study, factors involved in angiogenesis including sEng, Pgf and sFlt1 were investigated for pre-recognition of preeclampsia. Methods: A total of 54 pregnant women were included in the study and the patients were divided into normotensive (n = 25) and preeclampsia groups (n = 29). Both groups demographic characteristics, laboratory parameters, sEng, sFlt1 and placental growth factor levels were compared. Results: While AST, uric acid, LDH mean values were significantly higher in the study group compared to the control group (p<0.05), there was no significant difference between the groups in terms of ALT, creatinin, hemoglobin, leucocyte, and platelet values. sEng, sFlt1 values were significantly lover in the preeclampsia group compared to the control group (p<0.05). Conclusion: it is thought that Pgf may have a place in the prediction of preeclampsia in advanced pregnancy weeks, but sFlt-1 and sEng are weak in predicting preeclampsia in advanced pregnancy weeks as well.

Failure of Implantation in IVF due to oxidative stress

Oxidative stress may play a role in implantation failure on multiple levels. Oxidative stress is found widely in several biological systems, as well as it acts on various molecular levels with different mechanisms. It has been shown that it is rather the disequilibrium between reactive oxygen species causing oxidative stress and antioxidant mechanisms counteracting their effects, than reactive oxygen species levels themselves. Reactive oxygen species play a role in implantation and fertilisation by acting on different levels of embryo-formation and endometrial changes. Additionally, it is widely abundant in the female reproductive tract including ovaries, oocytes, tubal as well as follicular fluid. Moreover, it has been shown that male fertility is affected by reactive oxygen species by determining sperm quality. Last but not least, oxidative stress may affect IVF indirectly through its actions on peritoneal fluid. As long as research studies on elucidating the development of oxidative stress markers on patients undergoing IVF continue, ever more new possibilities emerge on predicting the pregnancy outcome.

Physical activity and exercise during pregnancy in Greece: A cross-sectional study

Introduction: Physical activity and exercise during pregnancy is regarded safe and beneficial in absence of pregnancy complications. The aim of this cross-sectional study is to describe physical activity of pregnant women in Greece and explore if it changes during pregnancy compared to the period before pregnancy. Material and Methods: The study was conducted in a private maternity hospital. Women were asked to fill in an adapted questionnaire based on Pregnant Physical Activity Questionnaire; birth outcomes and anthropometric measurements of the neonate were collected by the research midwife. Results: In our study population of 193 pregnant women, approximately half reported no or minimal physical activity during pregnancy and were less active than current guidelines’ recommendations. Gynaecologist’s opinion regarding exercise during pregnancy was conceived as positive only by a minority of women. Overall, women were less active during pregnancy than before, although they spent more time slowly walking for fun or exercise. Lastly, significant decrease was observed in all occupational activities involving slow or quick walking and lifting weights. Conclusions: These results indicate that systematic counselling of pregnant women regarding physical activity and exercise during pregnancy will be needed to achieve optimal physical activity levels for the majority of women in Greece.

Overweight in childhood and early adulthood is associated with parental Body Mass Index and perinatal risk factors

Background: To investigate the associations of pregnancy and pre-pregnancy parental characteristics on child’s weight and progression at the early adulthood. Material and Methods: Α random sample of 5,125 dyads children and their mothers was assessed. Mothers were asked to provide information contained in their medical booklets and pregnancy ultrasound records. With the use of a standardized questionnaire, telephone interviews were carried out for the collection of parental factors and offspring’s BMI. Results: Mother’s overweight (including obesity) before pregnancy was found to significantly increase the likelihoods of offspring’s overweight (including obesity) at the age of 8-9 years and 15-25 years (odds ratio (OR) 1.97; 95% confidence interval %CI: 1.65, 2.30 and OR 2.0; 95%CI: 1.67, 2.36, respectively). Paternal BMI (OR 1.41; 95% CI: 1.20–1.62), maternal smoking at pregnancy (OR 1.22; 95% CI: 1.14–1.30), gestational weight gain (OR 1.44; 95% CI 1.24–1.66), and gestational hypertension OR 1.30; 95% CI 1.14–1.49) were also found to significantly increase the odds of children’s obesity. Conclusion: Among prenatal factors considered, mother’s pre-pregnancy and father’s BMI, GWG, not breastfeeding, smoking in pregnancy and gestational hypertension increased the odds of offspring’s overweight/obesity in childhood and early adulthood, even after adjustment for several covariates.