Assessment of airway inflammation with exhaled NO measurement

Hippokratia 2007, 11, (2): 51-62

E Hatziagorou, J Tsanakas
3rd Paediatric Dpt, Aristotle University of Thessaloniki, Paediatric Pulmonology Unit, Hippokration Hospital, Thessaloniki, Greece


Abstract

Assessing airway inflammation is important for in­ves­ti­gating the underlying mechanisms of many lung dis­eases, including asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, primary ciliary dys­ki­ne­sia (PCD) and cystic fibrosis. A growing interest has recently directed toward non-invasive methods for the assessment of airway in­flammation.
Measurement of exhaled nitric oxide in exhaled air is an exciting inno­vative technique that gives new insights into the patho­physi­ology of lung disease and asthma in particular, with many potential clinical applications. Careful standardisation of measurement techniques has fa­cili­tated the use of this new measurement in paediatric res­pi­ratory medicine. Non-inva­siveness and instantaneous results potentially make it a suitable instrument for use in children starting from the age of 4, with useful appli­cations both in asthma diagnosis and monitoring

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Epithelial ovarian cancer. Risk factors, screening and the role of prophylactic oophorectomy

Hippokratia 2007; 11 (2): 63-66

A Daniilidis, V Karagiannis
3rd Dpt of Obstetrics and Gynaecology, Hippokration Hospital, Thessaloniki, Greece


Abstract

Epithelial ovarian cancer is the seventh most frequent can­cer in European women. Many theories have been pos­tu­lated regarding the pathogenesis of ovarian can­cer. Risk factors are not well defined, with the ex­ception of low parity and oral contraceptive use. Approxi­mately 10% of ovarian cancer are hereditary, with BRCA1 and BRCA2 ex­plaining the majority (approxi­mately 90%) of hereditary ovarian can­cer cases. The lifetime risk varies between 15 and 66%, sug­ gesting the existence of modi­fying genetic or en­vi­ron­men­tal factors. Family history can be used to define women who are at increased risk of ovarian cancer. Individuals at high risk are those with a first degree relative (mother, father, sister, brother, daugh­ter or son) affected by can­cer. It must be noted that currently available tests do not attain the afore­men­tioned high level of sensitivity. Evidence suggest that presymptomatic screening by grey scale ul­tra­sound (with or without Doppler), CA125, pelvic examination, or com­bi­nations of these, are not effective in detecting tumors at an early stage. Women identified as being at high risk of ova­rian cancer can be offered pro­phy­lac­tic oophorec­tomy. The decision whether or not to proceed to pro­phy­lac­tic oophorec­tomy is influenced by the fact that most women at in­creased risk of ovarian cancer are also at increased risk of breast cancer and there is evi­dence that oophorec­tomy reduces breast cancer in these cases.

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Pruritus in certain internal diseases

Hippokratia 2007; 11 (2): 67-71

D Yonova
Dialysis Clinic, Med. Univ. Hospital ”Alexandrovska”, Sofia, Bulgaria


Abstract

In the past it was widely believed that pain and itching are transmitted by the same nerve pathway with the low intensity stimulation of unmyelinated polymodal C fibers resulting in sensation of pruritus whereas high intensity stimulation causing pain. In recent experiments however, stimulation of single unmyelinated C fibers led to the identification of two kinds of fibers. Stimulation of most of these fibers induces pain, whereas a small number of fibers provoke the sensation of itching. Pruritus is an unpleasant sensation, often accompanied by scratching. It may present due to a number of cutaneous diseases or internal disorders. Pruritus may be caused by some chemical substances as histamine, prostaglandins, proteases and substance P. This review describes the existence of pruritus in different internal disorders. It is quite important the reason of pruritus to be discovered, for the application of an adequate therapy.

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Keywords: pruritus, unpleasant sensation, itching, internal diseases, antihistamines, cholestasis, uremia, dialysis, malignancy

Correspoding author: Yonova D, Dialysis Clinic, Med. Univ. Hospital “Alexandrovska”, “G. Sofijski” Str. No 1, Sofia 1431, Bulgaria. tel. 35929230463; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


Hypertension and progression of nephropathy in diabetic and non-diabetic chronic kindney disease patients

Hippokratia 2007; 11 (2): 72-76

O Stojceva-Taneva, G Selim, L Stojkovski, N Ivanovski
Dpt of Nephrology, University Clinical Center, Skopje, F.Y.R.O.M.

Abstract

Background: Hypertension is associated with more rapid progression of chronic kidney disease. Several studies have shown that treating hypertension in patients with chronic kidney disease and proteinuria may attenuate the decline in glomerular filtration rate.
Study objective: The study evaluates the prevalence of hypertension and its association with chronic kidney disease progression in patients without and with diabetic nephropathy.
Methods: Patients with CKD stage 2-4 were followed up by a nephrologist for 12-52 months. A total of 137 patients were included in the study, 70 with non-diabetic CKD and 67 with type 2 diabetes and diabetic nephropathy. Demographic and clinical parameters were recorded at initiation and during follow-up. Glomerular filtration rate was estimated by the Cockroft-Gault formula and progression of CKD by the slope of the estimated GFR decline .
Results: Out of 70 patients in the non-diabetic group, 34 were males, (mean age 50.37±12.2 years). Out of 67 diabetic patients, 30 were (males, mean age 57.8±8.4 years). 77% in the non-diabetic group had SBP above 140 mmHg. The higher SBP was associated with older age, (53.16±10.8 vs 40.9±12.2 years, p<0.0001). Diastolic blood pressure above 90 was present in 73%. Pulse pressure above 80 had 5.7% and was associated with older age (p<0.02). Progression of chronic kidney disease correlated inversely with age, and positively with diastolic blood pressure and proteinuria (p=0.005, p=0.019 and p=0.02 respectively). Multiple regression analysis showed that only younger age and higher proteinuria were predictive for chronic kidney disease progression (p=0.00002). 6% of pts in the diabetic group had SBP below 140, 19% between 140 and 160, and 75% above 160 mmHg. Diastolic blood pressure below 80 had only 6% of patients, between 80 and 90 had 37% and above 90 mmHg had 57%. Pulse pressure below 80 mmHg had 55% and it was correlated positively with age, p=0.009. Progression of chronic kidney disease in the diabetic group correlated positively with mean arterial pressure, systolic blood pressure and proteinuria, (p=0.017, 0.036 and 0.000000 respectively) and inversely with age (p=0.0003). Multiple regression analysis showed that proteinuria, age and SBP were the only predictors for chronic kidney disease progression in diabetics.
Conclusion: Isolated systolic hypertension predominates the older age groups, proteinuria and age significantly correlate with GFR decline in both groups, and SBP is associated with more rapid progression of CKD in the diabetic patients.

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Preoperative evaluation, surgical procedure, follow up and results of 150 cochlear implantations

Hippokratia 2007; 11 (2): 77-82

G Kyriafinis, V Vital, A Psifidis, J Constantinidis, A Nikolaou, M Hitoglou - Antoniadou, A Kouloulas
Cochlear Implantation Center, 1st Otolaryngology Department of Aristotle University, AHEPA Hospital, Thessaloniki, Greece

Abstract

Background: The cochlear implantation is among the most important achievements of medicine and biotechnology in the last 20 years, because it allows individuals who had never heard or had lost their hearing to perceive sound and improve their quality of life. Selection criteria for candidates are strict and are evaluated in each individual by a scientific committee specially trained for implantations which includes Ear Nose and Throat (ENT) surgeon, audiologist, psychiatrist and speech therapist.
Patients and methods: In our department, the first cochlear implantation was performed in 1995. During the last ten years more than 250 individuals have been evaluated due to profound hearing loss and 170 of them were found to be suitable candidates for cochlear implantation. One hundred and fifty (150) have already been operated and most of them are children with congenital hearing loss. No major or permanent complications were recorded in any of our 150 patients. Activation and fitting/mapping of the cochlear implant is initiated three weeks post-operatively. Regular follow-up and mapping of the implant are held, more frequently in children, along with specialized speech therapy. Each new mapping is evaluated according to the record of the patient with regard to the acoustic perception of sounds and speech and the discrimination of individual elements of phonation based on a protocol that we have created for the needs of Greek language.
Results: Speech discrimination (AHEPA Hospital protocol), before the Implantation, at the activation of the cochlear implant and till 4 years of the follow-up showed that in our patients, we obtained better and faster results in post-speech acquisition adults with recent or chronic deafness and in children with congenital deafness operated before the 5th year of age, who underwent special preoperative speech therapy programme, fact which is in agreement with current literature. Patient satisfaction evaluated by 'Sanders' psychometrics tests, was achieved in accordance to pre-operative expectations.
Conclusions: In our patients, we observed better and faster results in children with congenital deafness operated before the third year of age, in post-speech acquisition adults with recent deafness and in post-speech acquisition adults with chronic deafness but with auditory memory reserve.

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Efficacy of captopril therapy in cystinuria lithiasis. A case report

Hippokratia 2007; 11 (2): 83-85

N Printza, F Koukourgianni, A Papathanasiou, P Augoustides-Savvopoulou, F Papachristou
1st Dpt of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
Pediatric Dpt, General Hospital of Veria, Veria, Greece
Urology clinic, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

We present a 7-year old girl with severe urolithiasis due to cystinouria. Medical treatment after the surgical procedures was initiated with intensive hydration, urine alkalinisation and captopril. We discuss the therapeutic efficacy of captopril in resolving lithiasis as well as in preventing new stone formation.

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Management of a giant ruptured hepatocellular adenoma

Hippokratia 2007; 11 (2): 86-88

V Papanikolaou, D Giakoustidis, K Patsiaoura, G Imvrios, N Antoniadis, N Ouzounidis, V Nikopolitidis, A Antoniadis
Dpt of Transplantation Surgery
Dpt of Pathology, Aristotle University, Hippokration Hospital, Thessaloniki, Greece

Abstract

This report describes a rare case of a young woman with massive intra-abdominal bleeding due to a giant ruptured hepatocellular adenoma. The patient had never used oral contraceptive pills and she was urgently operated for haemorrhage control in another hospital where the left hepatic artery was also ligated. After haemodynamic stabilization in the ICU and because of a complicated postoperative course (signs of intraabdominal sepsis) she was transferred to our hospital and a left lobectomy was performed. We present the case and comment on the preferred treatment modalities of hepatocellular adenomas.

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Trichoblastic carcinoma of the pinna. A rare case

Hippokratia 2007; 11 (2): 89-91

S Triaridis, S Papadopoulos, A Printza, E Grosshans, B Cribier
Department of Otolaryngology, Hippokratio General Hospital, Thessaloniki, Greece
2nd Academic Otolaryngology Department, Papageorgiou General Hospital, Thessaloniki, Greece
Department of Pathology, General Hospital of Veria, Veria, Greece
Clinique Dermatologique, Universite Louis Pasteur, Faculte de Medecine, Strasbourg, France

Abstract

Adnexal tumors of the hair follicle can be regarded as lesions that show similar differentiation to one or more portions of the hair follicle. Trichoblastic carcinoma is a rare malignant adnexal tumor, which usually occurs on the scalp.We report a case of a 65 years old man with a painless irregular mass of the posterior surface of the right pinna, which was slowly growing over a 5-year period. He had a history of a similar lesion on the same site, which was removed 8 years before he presented to us. We excised the lesion and the defect was covered with an advancing flap. Because of the histology result the patient was re-operated and reviewed for over 3 years and there wasn't any sign of recurrence.

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Human and ape: the legend, the history and the DNA

Hippokratia 2007; 11 (2): 92-94

A A Diamandopoulos, P C Goudas
“St. Andrews” General State Hospital, Patras, Greece

Abstract

A vast amount of papers is published every year about species evolution, the most interesting being those recently published in the journal 'Nature', concerning the human-ape relationship. The results and the new theories generated from this research are sometimes astonishing, rising not only biological, but also social, reli gious and cultural questions. One of the new questions concerns the role of species interbreeding as a means of evolution. In the subject of species interbreeding between human and ape we found some interesting historical and mythical information that sort of back-up this theory of interbreeding, with a historical and cultural side of view.

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