Hemolytic Uremic Syndrome after Renal Trasplantation

Hippokratia 2006; 10 (3): 99-104

G Vergoulas
Organ Transplant Unit, Hippokratio Hospital, Thessaloniki, Greece

Abstract

Hemolytic Uremic Syndrome after kidney transplantation affects an increasing number of patients. It is characterized as recurrent and de novo. Older age at onset of HUS, shorter mean interval between HUS and transplantation or ESRD, living related donor and treatment with CNI have been associated with an increased risk of recurrence. Patients who lost the first transplant because of HUS recurrence should not receive a second transplant. The outcome of recurring HUS after transplantation is worse in familial forms leading invariably to graft loss and for this reason doctors should discourage the use of living related donors in this setting. De novo HUS is not a rare complication after kidney transplantation and may be associated with infection, CNI or mTOR inhibitor toxicity, antibody use (OKT3), or acute vascular rejection. The clinical picture is obscure and treatment rests on removal of inciting factor with or without plasma exchange / FFP infusion.

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Late pregancy complications in polycystic ovarian syndrome

Hippokratia 2006; 10 (3): 105-111

I Katsikis, M Kita, A Karkanaki, N Prapas, D Panidis
Division of Endocrinology and Human Reproduction
2nd Dpt Obtetrics and Gynecology, Aristotle University, Thessaloniki, Greece

Abstract

Gestational diabetes mellitus and new-onset hypertension, which includes gestational hypertension and pre-eclampsia, are common complications of pregnancy. Many features of the insulin resistance syndrome have been associated with these conditions. These include glucose intolerance, hyperinsulinemia, hypertension, obesity, and lipid abnormalities. Other accompanying abnormalities may include elevated serum levels of leptin, TNFa, plasminogen activator inhibitor-l and testosterone. The establishment of these features before the onset of gestational diabetes mellitus and hypertension in pregnancy suggests that insulin resistance or associated abnormalities may play a role in these disorders. These observations suggest that therapeutic interventions to reduce insulin resistance may lower the risk of both gestational diabetes mellitus and hypertension in pregnancy.

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RNA Interference: A powerful laboratory tool and its therepeutic implications

Hippokratia 2006; 10 (3): 112-115

K Felekkis, C Deltas
Dpt of Biological Sciences, University of Cyprus, Cyprus

Abstract

Ever since RNA interference (RNAi) was discovered in the ear1y 1990s, a number of scientists from the academic and biotechnology world have continued to view it as the revolutionary discovery of the century. Unequivocally, RNAi can be considered as an important regulator of gene expression in many eukaryotic cells. The term RNAi describes a natural process by which a double-stranded RNA molecule, when introduced into the cell is processed into short RNA duplexes and drives gene silencing by specific and distinct mechanisms. Many of the players involved in this cellular defense network have been elucidated but a more complete understanding of the process is essential. Worldwide interest on RNAi in the last decade is mainly attributed to its power as a laboratory tool for the experimental manipulation of gene expression. RNAi assisted already in the dissection of numerous cellular pathways and revealed the role of many proteins in an approach aimed to drug discovery. This new technology has the potential to improve our understanding of physiologic and pathologic processes and lead to the discovery of new drugs. More importantly, there is growing interest among the scientific community for the potential therapeutic applications of RNAi.

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What's new in p53?

Hippokratia 2006; 10 (3): 116-119

D Maritsi, D Stagikas, K Charalabopoulos, A Batistatou
Dpt Physiology, Clinical Unit, Ioannina University Medical School, Ioannina, Greece
Dpt Pathology, Clinical Unit, Ioannina University Medical School, Ioannina, Greece

Abstract

p53 is the main intrinsic factor inducing apoptosis by recognizing the external stimuli and activating the p53 responsive genes to an irreversible series of events. P53 activates the transcription of specific proapoptotic genes called p53 target genes.
A growing number of p53 responsive genes have been identified and numerous studies have demonstrated that p53 proapoptotic factors such as Noxa, Puma and Perp play cell type specific roles in p53's mediated response to certain stimuli. Perp (p53 apoptosis effector related to PMP-22) is a direct proapoptotic target gene encoding a tetraspan protein. Perp is highly expressed in cells undergoing apoptosis compared to cells under G1 arrest and its overexpression is sufficient to cause cell death in fibroblasts. Noxa is another member of the preapoptotic p53 genes family. When expressed Noxa acts in a BH3 motif-dependent localization to mitochondria, causing structural changes, activation of caspase 9 and release of cytochrome c from mitochondria to cytosol. Puma (p53 mutant of apoptosis) is another critical mediator of p53-dependent apoptosis. P53 binds to Puma-promoter gene sites, leading to puma production. The mtCLIC, a member of intracellular chloride channels, is a cytoplasmic and mitochondrial protein positively regulated by p53. Caspase 10 is induced in p53-dependent manner leading to cellular apoptosis. Other newly announced factors are also involved in p53-regulated apoptosis such as brain-specific angiogenesis inhibitor - 1 (BSAI-1), MSOD and GPX genes. A global discussion on this topic is attempted in the present review article.

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Anovulation and ovulation induction

Hippokratia 2006; 10 (3): 120-127

I Katsikis, M Kita, A Karkanaki, N Prapas, D Panidis
Division of Endocrinology and Human Reproduction
2nd Dpt of Obstetrics and Gynecology, Aristotle University, Thessaloniki, Greece

Abstract

Conventional treatment of normogonadotropic anovulatory infertility is ovulation induction using the antiestrogen clomiphene citrate, followed by follicle-stimulating hormone. Multiple follicle development, associated with ovarian hyperstimulation, and multiple pregnancy remain the major complications. Cumulative singleton and multiple pregnancy rate data after different induction treatments are needed. Newer ovulation induction interventions, such as insulin-sensitizing drugs, aromatase inhibitors and laparoscopic ovarian electrocoagulation, should be compared with conventional treatments. Ovulation induction efficiency might improve if patient subgroups with altered chances for success or complications with new or conventional techniques could be identified, using multivariate prediction models based on initial screening characteristics. This would make ovulation induction more cost-effective, safe and convenient, enabling doctors to advise patients on the most effective and patient-tailored treatment strategy.

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Regulation of the FOXM1 transcription factor by the estrogen receptor á at the protein level in breast cancer

Hippokratia 2006; 10 (3): 128-132

C T Karadedou
Dpt Molecular Oncology, Medicine, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College, London, UK

Abstract

Breast cancer is the most frequent type of cancer of women in the western world. Antiestrogens, including Tamoxifen (OHT) and Faslodex (ICI), are widely used in the endocrine treatment of breast cancer. However, the majority of breast cancers are either resistant to endocrine therapy or eventually become unresponsive to antiestrogen therapy. Better understanding of the molecular mechanisms that govern tumour proliferation, is therefore needed to develop new therapies for the disease.
The Forkhead family of transcription factors plays an important role in regulating cell proliferation, cell death and differentiation.The estrogen receptor (ER) a positive breast carcinoma cell line MCF-7 and the ERa negative line MDA-MB-231 was used to study the potential regulation of the Forkhead member FOXMl by ER. It was indicated that estrogen and ER regulate the expression of FOXMl at the protein level.
Since Forkhead proteins play an important role in regulating cell proliferation, cell death and differentiation, this study helps to explain some of the functions of ER in tumourigenesis, and the way these Forkhead proteins could be crucial targets for therapeutic strategies and/or markers for diagnosis and prognosis.

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Diagnostic value of the Convetional and Doppler ultrasound in pregnancy complicated with preeclampsia

Hippokratia 2006; 10 (3): 133-137

M Lubomirova, E Andreev, B Bogov, R Djerassi, B Kiperova, A Nikolov, V Stoykova, V Diavolov, A Dimitrov
Clinic of Nephrology, Medical University Hospital "Alexandrovska", Sofia, Bulgaria

Abstract

Background. Preeclampsia (PE) is a pregnancy complication usually of the third trimester. The clinical manifestations are hypertension and proteinuria with or without edema. Its pathogenesis is characterized by generalized vasoconstriction and endothelial dysfunction. The aim of this study was to evaluate the diagnostic value of the Doppler ultrasound examination of the renal interlobar vessels in pregnancy complicated with preeclampsia in the context of the theory about the increased vessel resistance in this pregnancy disorder.
Methods. Fifty two women aged 16-38, (mean age 23??9.54) streamed into three groups were examined by abdominal ultrasound in Triplex regime. The first group included 18 pregnant with PE, the second 21 women in the third trimester of normal pregnancy, and the third group 13 non-pregnant women. In all 3 groups the renal volume (RV) and parenchyma volume (PV) were determined by conventional ultrasound (CU). The doppler waveform analysis (DWA) of the interlobar renal arteries (IRA) gave the following indices: resistance index (RI), pulsatility index (PI), peak systolic velocity (Vmax) and end diastolic velocity (Vmin).
Results. RV and PV in the PE group were significantly higher than those of the healthy pregnant women: RV: 231.4??58 to 187??45, p < 0.05 and for PV: 200??11 to 130??6.78, p < 0.05. Such a difference was not found out for the healthy pregnant women compared to the non-pregnant ones. No significant differences of the examined doppler indices were found in the three groups.
Conclusion. Although the arteriolar vasoconstriction and the tissue hypoxia are leading in the PE pathogenesis, the DWA of the IRA in PE pregnancy does not differ from those of the healthy pregnant and nonpregnant women. As one of the most frequently used imaging technique Doppler Ultrasou (DU) of the renal IRA and DWA of these vessels shows no diagnostic advantage as compared to the renal CU in pregnancy complicated with PE.

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Pulmonary embolism:CT findings with the use of helical computer tomography

Hippokratia 2006; 10 (3): 138-141

G Grollios, Ir Kazantzidou, V Georgopoulou, Th Karakozoglou, A Kotoula, G Michailidou, E Kourou, K Georgitziki
Radiology Dpt, Hippokratio Hospital, Thessaloniki, Greece

Abstract


Aim. The aim of this study is the presentation of the imaging findings in patients with pulmonary embolism, the diagnosis of which was made with the use of helical computed tomography.
Material and Methods. The lung CT scans of 14 patients were retrospectively studied. The presence of hypoattenuating thrombus within the lumen of one or more pulmonary arterial branches was considered as the imaging criterion for the diagnosis of pulmonary embolism.
Results. Emboli within the lumen of 1st order branches were found in 2 patients, within the lumen of 2nd order branches in 8 patients, into the lumen of 3rd order branches (lobar) in 10 patients and into the lumen of 4th order branches (segmental) in 6 patients. No emboli were detected in sub segmental or more peripheral branches. Concomitant, secondary findings were the presence of unilateral pleural effusion, areas of pulmonary oligaemia and the presence of a wedge-shaped, pleural-based opacity, indicative of a pulmonary infarct.
Conclusion. In conclusion, we were able to make the diagnosis of pulmonary embolism through the direct visualization of intraluminal emboli up until the segmental level, as well as of concomitant, accessory findings of pulmonary embolism.

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