Male infertility and varicocele: myths and reality

Hippokratia 2007; 11 (3): 99-104

D P Kantartzi, D Ch Goulis, D G Goulis, I Papadimas

Abstract

Varicocele is among the most common causes of male infertility. It is also one of the most controversial issues in the field of Andrology, especially regarding why, when and to whom varicocelectomy should be applied. Many experts believe that the surgical repair of varicocele should be applied only in a meticulously selected group of infertile men, although there are no generally accepted criteria. Up to now, the only confirmed prognostic factor for achievement of pregnancy after varicocelectomy is the age of the female partner. Given the wide application of intra - cytoplasmic sperm injection (ICSI) during the last few years, the modern research approaches should compare the benefits of varicocelectomy and ICSI, taking under consideration both the efficacy and the cost-effectiveness of the methods.

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Microalbuminuria, is it so important?

Hippokratia 2007; 11 (3): 105-107

A Koroshi

Abstract

Microalbuminuria (defined as urinary albumin excretion of 30-300 mg/day, or 20-200 ??g/min) is an earlier sign of vascular damage. It is a marker of general vascular dysfunction and nowadays is considered a predictor of worse outcomes for both kidney and heart patients. There is a significant correlation between blood pressure and microalbuminuria.Even high normal blood pressure is associated with significant higher frequency of microalbuminuria and this way may be a biomarker of increased cardiovascular risk. Microalbuminuria could be taken also, as an indicator of insulin resistance and of the increased renal and cardiovascular risk associated with metabolic syndrome. Renal involvement is a pivotal development in diabetes and microalbuminuria is generally the first clinical sign of renal dysfunction in diabetics. It is demonstrated that cardiovascular and renal risk is elevated even in the high normal range of microalbuminuria (below 30 mg/day). There is no doubt that therapies that prevent or delay the development of microalbuminuria and all measures that reduce it, may help to prevent or delay end organ damage.

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Is the Y chromosome all that is required for sex determination?

Hippokratia 2007; 11 (3):120-123

A Karkanaki, N Praras, I Katsikis, M Kita, D Panidis

Abstract

The gender identity of a person is the final result of genetic, hormonal and morphologic sex. Over a long period sex determination, and, specifically, male sex determination, has been correlated to the presence of the Y chromosome, which in turn has been the karyotype signal of the testes. However, research has provided data to convince that this theory is only part of the truth. In addition to the Y chromosome, a multitude of other genes influence sex determination and are able to cause male to female sex-reversal and vice versa. It is of great interest that these genes are located in more than one autosomal chromosomes or even in the X chromosome. It has become obvious that sex determination, according to the genetic sex, is a complicated matter that not only requires the presence of Y chromosome. This fact triggered extensive research of the Y chromosome and led to great insight into its structure, origin, evolution and eventual fate in humans.

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The kinin system - bradykinin: biological effects and clinical implications. Multiple role of the kinin system - bradykinin

Hippokratia 2007; 11(3):124-128

Ch Golias, A Charalabopoulos, D Stagikas, K Charalabopoulos, A Batistatou

Abstract

The present review article regarding the kinin system bradykinin is dealing with the biological effects of the abovementioned entity mediated by specific B1 and B2 receptors as well as with its clinical implications known nowadays. The activation of the kinin system-bradykinin is particularly important in blood pressure regulation and in inflammatory reactions, through bradykinin ability to elevate vascular permeability and to cause vasodilatation in some arteries and veins. Recent data on bradykinin formation and release, synergy with ligands, receptors for bradykinin as well as on bradykinin participation in the mitogenesis process, are given in detail. Therapeutic potentials and future applications in many clinical situations including respiratory allergic reactions, septic shock, hypertension and its treatment, hypotensive transfusion reactions, heart diseases, pancreatitis, hereditary and acquired angioedema, Alzheimer disease and liver cirrhosis with ascites, are discussed in brief. Its role as a neuromediator, regulator of several vascular and renal functions, and its participation in signaling pathways, is also discussed in some detail.

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Rhabdomyolysis updated

Hippokratia 2007; 11 (3): 129-137

G Efstratiadis, A Voulgaridou, D Nikiforou, A Kyventidis, E Kourkouni, G Vergoulas

Abstract

Rhabdomyolysis constitutes a common cause of acute renal failure and presents paramount interest. A large variety of causes with different pathogenetic mechanisms can involve skeletal muscles resulting in rhabdomyolysis with or without acute renal failure. Crush syndrome, one of the most common causes of rhabdomyolysis presents increased clinical interest, particularly in areas often involved by earthquakes, such as Greece and Turkey. Drug abusers are another sensitive group of young patients prone to rhabdomyolysis, which attracts the clinical interest of a variety of medical specialties. We herein review the evidence extracted from updated literature concerning the data related to pathogenetic mechanisms and pathophysiology as well as the management of this interesting syndrome.

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Investigation of the relationship between allergic rhinitis and personality traits using semeiometry

Hippokratia 2007; 11 (3): 138-141

N Gelis, E Prokopakis, E Helidonis, G Velegrakis

Abstract

Mind-body interactions have been well recognized and are extendedly studied in the medical literature. There is evidence that the mind and body communicate with each other in a multidirectional flow of information by means of hormones, neurotransmitters/neuropeptides, cytokines, and semaphorines. There are consistent and convincing reports of links between stress and disease onset and progression, e.g. asthma. Growing evidence in the field of psychoneuroimmunology contributes to the understanding of the mechanisms by which stressful events affect physical health. The psychoneuroendocrine system can influence the immune response and thereby the capacity of the organism to cope with illness, and the immune system can have an impact on neuroendocrine function. Such cross-talk among systems is dependent upon feedback loops working to maintain homeostatic equilibrium. The immune system is capable of producing factors, which serve to integrate immune-neuroendocrine circuits with immunoregulatory and metabolic consequences for the organism. The interaction of the immune, nervous and endocrine system may drive an individual to a well recognized biological hypersensitivity and the creation of allergic symptoms (allergic rhinitis, asthma, atopic dermatitis, etc), followed by distinct behavioural patterns characterized as affective hypersensitivity. Semeiometry is a proper tool for large scale investigation of the psychological profile of patients with allergic rhinitis. Statistical analysis of semeiometry questionnaires processed by Greek adult patients in Crete island during 2005, showed that there is relation between occupation and allergy. Housewives, public services employees and private employees appear to be allergic in significantly higher percentage than others. With semeiometry we can find evidence of the bi-directional immunoendocrine - nervous system interactions in patients with allergic rhinitis.

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L-arginine supplementation does not affect chemically induced carcinogenesis and tumor growth in BALB-c mice

Hippokratia 2007; 11(3):142-144

T Eleftheriadis, S Voyatzi, T Sparopoulou, C Kartsios, E Yiannaki, G Antoniadi, V Liakopoulos, G Galaktidou

Abstract

T-cell \E6-chain downregulation is common in various types of cancer and it is proposed as a mechanism of cancer immunosubversion.L-arginine consumption by arginase rich suppressor myeloid cells has been incriminated. The effect of L-arginine supplementation on chemically induced carcinogenesis and tumor growth in mice was evaluated.Methods: Eight-week old female BALB-c mice were used. Ten mice were injected i.m. with 0.6 mg methylcholanthrene (MCA) once. Ten mice were injected with MCA once and were receiving L-arginine supplementation (5% in animal drinking water) continuously during the study. Mice with cancer were sacrificed 12 weeks after.Results: From the 10 MCA injected mice 6 developed sarcoma. From the 10 MCA injected mice that were receiving L-arginine supplementation 7 developed sarcoma. L-arginine supplementation did not affect MCA induced carcinogenesis(p=1.0, Fisher???s exact test). The weight of tumors was not different between the tumors derived from mice that were or were not receiving L-arginine supplementation (1088.3??590.2 mg vs. 969.6??608.1 mg respectively, p=0.729, unpaired t-test).Conclusion: L-arginine supplementation does not affect chemically induced carcinogenesis and tumor growth in BALB-c mice. Although \E6-chain downregulation could be a mechanism of cancer immunosubversion there are enough other cancer immunosubversion mechanisms that were not overwhelmed by L-arginine supplementation. Additionally, except cancer immunosubversion, cancer immunoselection is another, possibly more significant, mechanism of tumor escape from immunosurveillance.

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Is pepsin detected in the saliva of patients who experience pharyngeal reflux?

Hippokratia 2007; 11 (3): 145-149

A Printza, M Speletas, S Triaridis, J Wilson

Abstract

Objectives: To investigate if pepsin is detected, with an activity assay, in the saliva of patients with a clinical diagnosis of laryngopharyngeal reflux (LPR) and can therefore be used as a diagnostic marker of laryngopharyngeal reflux.Study design: Pilot, prospective study. Methods: Adult participants with a clinical diagnosis of LPR collected whole saliva samples on regular intervals for a day, and upon experiencing symptoms attributed to LPR. Patients were selected on the basis of presence of severe symptoms and laryngoscopic findings of laryngopharyngeal reflux and symptoms of gastroesopharyngeal reflux. They reported voice disorders, dysphagia, throat clearing, excessive secretions, breathing difficulties, cough, globus sensation and throat pain. Control participants reported the absence of pharyngeal and laryngeal symptoms and of symptoms of gastroesophageal reflux. Saliva samples were assayed with fibrinogen on an agarose gel plate. The detection of pepsin was based on the presence of peptic activity which was qualitatively evaluated. Results: The control participants had negative assays. No saliva samples from the LPR patients, collected at regular sampling, tested positive for pepsin. All the samples collected at the presence of symptoms and following regurgitation episodes tested negative for pepsin. Saliva samples pH ranged from 7 to 8. Conclusions: Pepsin was not detected, with an activity assay, in the saliva of patients with a clinical diagnosis of LPR. A concentration method might be more sensitive although saliva and swallowing physiology renders the detection of pepsin in the saliva difficult.

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Gitelmana's Syndrome (Familial hypokalemia-hypomagnesemia)

Hippokratia 2007; 11 (3):150-153

M Gjata, M Tase, A Gjata, Zh Gjergji

Abstract

Gitelman's syndrome (GS) is a heritable renal disorder characterized by hypomagnesemia, hypokalemia and hypocalciuria, and is distinct from Bartter's syndrome (BS). As compared to those with BS, patients with GS present at an older age, and they have a milder clinical picture, normal or slightly decreased concentrating urine ability, reduced urinary excretion of calcium, and permanently decreased serum magnesium level. GS is caused by defective NaCl transport in the distal convoluted tubule, and is linked to the gene encoding the thiazide sensitive Na-Cl-cotransporter located on chromosome 16q. Patients with BS, on the other hand, have mutations in the transporters in the thick ascending loop of Henle (NKCC2, ROMK, and C1C-Kb). Treatment of GS consists of magnesium salt replacement.Long term prognosis in terms of maintaining growth, preserving renal function and life expectancy is excellent.

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Ulnar sesamoid's fracture of the thumb: An unusual injury and review of the literature

Hippokratia 2007; 11(3): 154-156

E Fotiadis, E Samoladas, P Akritopoulos, A Chatzisimeon, K Akritopoulou

Abstract

Background: It concerns an unusual injury which is the result of a violent hyperextension or abduction of the pollex and even less frequently by direct injury. Aim: To increase our sensitivity and observation regarding thumb's injuries, because it is possible a fracture of the sesamoid not to be diagnosed.Material and Method: We present a case of an adult man, 35 years old, who suffered a violent hyperextension of the right pollex. The contribution of digital X-ray examination, which demonstrated a fracture of the ulnar sesamoid of the pollex was very important. The fracture was treated with fixation with elastic bandages for two weeks.Results: Follow up of the patient six weeks and six months after the injury, demonstrated a total recovery of the function of the pollex and callousness of the fracture, respectively. Conclusion: Fracture of sesamoid bones of the thumb is a rare injury, not usually diagnosed, but it has good prognosis when treated properly.

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The proteins and the mechanisms of apoptosis: A mini-review of the fundamentals

Hippokratia 2007; 11(3): 108-113

V Papaliagkas, A Anogianaki, G Anogianakis, G Ilonidis

Abstract

Apoptosis or programmed cell death is a physiological mechanism, characterized by specific morphological and biochemical changes such as cell shrinkage, chromatin condensation, protein cleavage, DNA breakdown and phagocytosis.Apoptosis is a significant contributor to the morphologic and functional development of multicellular organisms. It is also involved in the pathogenesis of several diseases including degenerative diseases of the central nervous system (CNS) like Alzheimer???s disease or Parkinson???s disease, cancer and immune system dysfunction. There are many factors,mainly proteins, which are involved in the activation, regulation and execution of related events. A fairly detailed outline of apoptotic mechanisms has also started to emerge and to be verified. In this short, focused mini-review, we attempt to outline current evidence regarding the mechanisms and the regulation of apoptosis.

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Blood pressure control and cardiovascular risk reduction

Hippokratia 2007; 11(3): 114-119

G Antonakoudis, L Poulimenos, K Kifnidis, C Zouras, H Antonakoudis

Abstract

The ultimate goal of antihypertensive therapy is cardiovascular risk reduction. As lowering blood pressure per se reduces risk for myocardial infarction only by 20% - 25%, it is obvious that a better protection is needed. An optimal strategy to reduce risk in hypertensives may include lifestyle modification, promotion of adherence to therapy, early and aggressive target levels achievement by appropriate drug choice. Clinical trial data suggest that RAAS blockers can reduce the risk at least partly independently of BP lowering.In addition, as hypertension is associated with a constellation of other risk factors, the global risk reduction is nowadays going to become the gold standard in therapy. The most common and important coexisting risk factor is hypercholesterolemia. This is not simply a co-existence but there is an independent and causal relationship between lipids and hypertension and there is a physiologic rationale and evidence for statins use especially in patients with complicated hypertension or in patients with more than two risk factors.So, whilst blood pressure lowering is undoubtedly beneficial, we have to focus on the global cardiovascular risk. We must go beyond blood pressure and the most effective way to go beyond BP is to add a statin.

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