Non-blood medical care in gynecologic oncology: a review and update of blood conservation management schemes

This review attempts to outline the alternative measures and interventions used in bloodless surgery in the field of gynecologic oncology and demonstrate their effectiveness. Nowadays, as increasingly more patients are expressing their fears concerning the potential risks accompanying allogenic transfusion of blood products, putting the theory of bloodless surgery into practice seems to gaining greater acceptance. An increasing number of institutions appear to be successfully adopting approaches that minimize blood usage for all patients treated for gynecologic malignancies. Preoperative, intraoperative and postoperative measures are required, such as optimization of red blood cell mass, adequate preoperative plan and invasive hemostatic procedures, assisting anesthetic techniques, individualization of anemia tolerance, autologous blood donation, normovolemic hemodilution, intraoperative cell salvage and pharmacologic agents for controlling blood loss. An individualised management plan of experienced personnel adopting a multidisciplinary team approach should be available to establish non-blood management strategies, and not only on demand of the patient, in the field of gynecologic oncology with the use of drugs, devices and surgical-medical techniques

Investigation of the relationship of heterogenity of genes coding for maternal and fetal platelets glycoproteins and intermembrane molecules with fetal intrauterine growth restriction

Vascular thrombotic tendency may lead to fetal growth restriction (FGR). Altered platelet function and genetic heterogeneity may play a role in this procedure. We investigated whether maternal or fetal genotypic frequencies of genes polymorphisms for certain platelet receptor and cell adhesion molecules are altered in FGR. We compared the maternal and fetal genotypic frequencies of single nucleotide polymorphisms (SNPs) in four genes coding for platelet receptors and cell adhesion molecules [integrin alpha subunit 2 (ITGA2)C807T, integrin subunit beta 3(ITGB3) T1565C, platelet cell adhesion protein 1 (PECAM1) CTG-GTG and selectin P(SELP )A/C]. A total of 32 fetuses with fetal growth restriction and their mothers were matched with 18 normal controls. Using maternal venous blood and umbilical cord blood samples, nucleotide sequences were determined from pyrograms. Genotypic frequencies were calculated and analyzed using appropriate tests and logistic regression. There was no statistical difference in the proportion of heterozygotes or homozygotes for any of the genotypic frequencies between FGR and control groups in mothers or fetuses. In conclusion,our study demonstrated no association of maternal or fetal ITGA2 C807T SNP, ITGB3 T1565C SNP, PECAM1 CTG - GTG and SELP A/C polymorphisms with FGR.Η αγγειακή θρομβωτική τάση μπορεί να οδηγήσει σε περιορισμό της ανάπτυξης του εμβρύου (FGR). Η τροποποιημένη λειτουργία των αιμοπεταλίων και η γενετική ετερογένεια μπορεί να διαδραματίζουν κάποιο ρόλο σε αυτή τη διαδικασία. Ερευνήσαμε κατά πόσον οι γονιδιοτυπικές συχνότητες σε μητέρες και πολυμορφισμών κάποιων γονιδίων, για ορισμένα μόρια υποδοχέα αιμοπεταλίων και κυτταρικής προσκόλλησης ,μεταβάλλονται σε κυήσεις με FGR. Συγκρίναμε τις μητρικές και εμβρυϊκές γoνότυπες συχνότητες των πολυμορφισμών ενός νουκλεοτιδίου (SNPs) σε τέσσερα γονίδια που κωδικοποιούν για υποδοχείς αιμοπεταλίων και μόρια κυτταρικής προσκόλλησης [υπομονάδα ιντεγκρίνης άλφα 2 (ITGA2) C807T, υπομονάδα ιντεγκρίνης βήτα 3 (ITGB3) T1565C, πρωτεΐνη προσκόλλησης κυττάρων αιμοπεταλίων 1 (PECAM1) CTG-GTG και σελεκτίνη Ρ (SELP) A / C]. Συνολικά 32 έμβρυα με περιορισμό της ανάπτυξης του εμβρύου και οι μητέρες τους συγκρίθηκαν με 18 φυσιολογικά ζεύγη ελέγχου (μητέρα – έμβρυο). Χρησιμοποιώντας δείγματα μητρικού φλεβικού αίματος και ομφαλοπλακουντιακού αίματος, οι αλληλουχίες νουκλεοτιδίων προσδιορίστηκαν από πυρογράμματα. Οι γονοτυπικές συχνότητες υπολογίστηκαν και αναλύθηκαν χρησιμοποιώντας κατάλληλες δοκιμές και λογιστική παλινδρόμηση. Δεν υπήρξε στατιστική διαφορά στην αναλογία των ετεροζυγώτων ή των ομοζυγώτων για οποιαδήποτε από τις γενοτυπικές συχνότητες μεταξύ FGR και ομάδων ελέγχου σε μητέρες ή έμβρυα. Συμπερασματικά, η μελέτη μας δεν έδειξε πιθανή συσχέτιση των μητρικών ή εμβρυϊκών πολυμορφισμών ITGA2 C807T SNP, ITGB3 T1565C SNP, PECAM1 CTG-GTG και SELP A / C με FGR

Customer satisfaction study with the Electre Tri method: the case of smartphones

Περίληψη: Η παρούσα διπλωματική αφορά τη διεξαγωγή μιας έρευνας ικανοποίησης πελατών με θέμα τα κινητά τηλέφωνα. Η μελέτη ικανοποίησης πελατών αποτελεί ένα βασικό ανταγωνιστικό πλεονέκτημα για τη γνώση των δυνατοτήτων και των επιδόσεων μιας επιχείρησης. Η έρευνα υλοποιήθηκε με τη βοήθεια της μεθόδου ELECTRE TRI για τον προσδιορισμό του επιπέδου ικανοποίησης. Η μέθοδος ELECTRE TRI χρησιμοποιείται σε προβλήματα ταξινόμησης όπου οι εναλλακτικές αντιστοιχίζονται σε προκαθορισμένες ομάδες κατηγορίες ανάλογα με τα κριτήρια τους. Πιο συγκεκριμένα, η κατανομή σ’ αυτήν την εργασία γίνεται σε τάξεις ικανοποίησης μέσα από το σύνολο των υπηρεσιών που παρέχει το προϊόν. Για την συλλογή των πληροφοριών που είναι απαραίτητες για την διεκπεραίωση της μελέτης έχει σταλεί ηλεκτρονικά ερωτηματολόγιο σε καταναλωτές σχετικά με τα κινητά τηλέφωνα. Εφόσον λήφθηκαν οι απαραίτητες πληροφορίες έγινε ανάλυση των στατιστικών στοιχείων με σκοπό την εξάλειψη των απαντήσεων που κρίνονται ακατάλληλα για το δείγμα. Στη συνέχεια, καθορίζονται οι κλάσεις ισοδυναμίας μαζί με τα όρια τους, καθώς και τα όρια προτίμησης και αδιαφορίας. Τέλος, υπολογίζονται τα αποτελέσματα ολικής ικανοποίησης, εξάγονται συμπεράσματα από τις επιμέρους αναλύσεις και προτείνονται μελλοντικές επεκτάσεις της εργασίας.Summarization: The present diploma thesis is referred to the conduct of a customer satisfaction study on smartphones. Customer satisfaction can be a very effective advantage in the market because it includes the knowledge of the skills and the performance of a company. This study occurs with the help of the Electre Tri method for the better outcome of the satisfaction level. This method is used for classification problems where alternatives are put in pre-existing categories depending on their criteria. More specifically, the classification of this study is on satisfaction classes according to the amount of services that the product provides. For the collection of the information needed for the study, a questionnaire is distributed to customers about their smartphones. When the information is taken, there is a statistical analysis for the elimination of the inappropriate elements for the sample. In addition, there is a determination of categories and their boundaries as well as a setting of preference and indifference thresholds. Finally, the Electre Tri method is compared to other methods for safer conclusions and for possible enhancement suggestions

Early evaluation of an organised mammography screening program in Greece 2004-2009

Objective: The aim of the current study was to present early performance indicators of a breast cancer screening program in Greece. Methods: Between March 2004 and July 2009, 9621 women aged between 40 and 69 years were recruited into programme on a voluntary basis. The participating women were residents of two adjacent administrative regions of Greece. Several performance indicators were calculated for the first and subsequent screen, separately. Results: A total of 9621 mammograms were 1st screens and 4462 were subsequent screens. The attendance rate was almost 1.5%. The technical repeat rate was 1.7%. On the 1st screen, the recall rate was 11.4%, while the recall rate of the subsequent screens was 5.5%. The vast majority of detected cancers were invasive and only the 1/7 of cancers was identified as DCIS. As concerns tumour size of invasive cancers, the 1.9% and 16.7% was unknown, in the first and subsequent screen, respectively. Moreover, 38.5% and 44.4% of cancers detected in the 1st and subsequent screen, respectively, were less than 15 mm in diameter. Almost 1/5 of diagnosed cancers were interval cancers. Conclusions: This breast cancer screening programme is the first one in Greece and the attendance rate is extremely low. Taking into account that an organised screening programme may benefit women with a reduction in breast cancer mortality, there is an urgent need to develop a national-based screening programme, to increase participation and to improve the information system used to monitor programme performance. (C) 2011 Elsevier Ltd. All rights reserved

Maternal serum pregnancy-associated plasma protein-A concentration at 11–14 weeks of gestation and preeclampsia risk of women with common congenital anatomic uterine abnormalities

To evaluate maternal serum pregnancy-associated plasma protein-A (PAPP-A) levels at 11–14 weeks of gestation and preeclampsia risk in women with common congenital anatomic uterine abnormalities (AUAs). First trimester screening markers were compared between 12 AUA pregnancies, 60 age matched controls and 12 cases of early preeclampsia. PAPP-A level and birth weight were significantly lower in AUA compared to control and early preeclampsia group (p<.001). Preeclampsia was absent in the AUAs pregnancies group. Birth weight were similar in AUA group when we compared AUA and control group regarding weeks of gestation at delivery and lower but not significantly, when we compared AUA and early preeclampsia group. Our findings suggest that AUA pregnancies are associated with low first trimester maternal serum PAPP-A concentrations not predictive of susceptibility to preeclampsia.Impact statement What is already known on this subject? During first trimester screening for preeclampsia based on maternal pregnancy-associated plasma protein A (PAPP-A) levels, various parameters are used, such as the somatometric characteristics of pregnant woman, single or multiple pregnancy, smoking status, family history, diabetes, hypertension and measurement of blood pressure and uterine artery Dopplers. What do the results of this study add? Our pioneer study revealed that there is drastic difference in PAPP-A concentration in women with common anatomic uterine abnormalities (AUAs), in comparison with their age matched control women with normal uterus. What are the implications of these findings for clinical practice and further research? Based on our results, uterine anatomical deviations, is another factor which must be taken in account for preeclampsia risk calculation and further clinical consultation and follow up in those pregnancies. Lower PAPP-A levels in AUA cases is a weak predictor of susceptibility to preeclampsia and could be associated to smaller placental size rather than poor placentation and in future research the calculation of the uterine cavity functional dimension may lead to a more accurate clinical assessment

Merkel cell carcinoma in pelvic lymph nodes after surgical staging for endometrial cancer: A case report and review of the literature

INTRODUCTION: Merkel cell carcinoma (MCC) is a rare malignant neuroendocrine tumor of the skin. PRESENTATION OF CASE: We present a case of MCC in pelvic lymph nodes, revealed after surgical staging for endometrial cancer. A 54-year-old Caucasian woman presented to our department with a threemonth history of postmenopausal bleeding. After proper preoperative evaluation, the patient underwent total abdominal hysterectomy, bilateral salpingo-ophorectomy and pelvic lymph node dissection. The pathology report confirmed the presence of a small, grade I, endometrioid adenocarcinoma and MCC in the pelvic lymph nodes. Primary site of the disease could not been retrieved. The tumor board decided adjuvant chemotherapy (carboplatin and etoposide) and close follow-up every 2 months. Our patient is alive with no evidence of disease 12 months after surgery. DISCUSSION: It is noteworthy that 19% of the patients with MCC had lymph node metastasis with no apparent primary lesion. The mechanism of this regression remains unclear, although a higher apoptotic activity has been observed in MCC than other skin tumors. In addition, other co-malignancies have also been linked to MCC patients. The explanation for the frequent occurrence of other primary neoplasms in patients with MCC is still unclear. However, a reasonable cause could be an altered genetic profile or an immuno-compromised situation in these patients. CONCLUSION: Further analytic investigations are needed to clarify the role of various factors in the spontaneous regression or not of this neuroendocrine tumor as well as in the simultaneous genesis of other primary carcinomas. © 2012 Surgical Associates Ltd