Current endovascular management of the ischaemic diabetic foot

T. Gerassimidis, CD. Karkos, D. Karamanos, A. Kamparoudis

Abstract

Ischaemic diabetic foot ulcers pose a significant problem which is associated with a high likelihood of amputation. With the advent of endovascular surgery, the management of lower limb arterial lesions in the diabetic population has become more appealing. Coronary 0.014 monorail guide wires, appropriate sized angioplasty balloons and stents, and subintimal recanalisation, are all useful adjuncts and techniques to achieve revascularization. This article reviews the modern endovascular management of the diabetic foot.

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Application of “Glottal Disturbogram” as a novel tool for the description of vocal

C. Pastiadis, G. Papanikolaou, A. Printza

Abstract

The paper introduces “Glottal Disturbogram” as a new tool for the discrimination, evaluation and representation of glottal disturbances which may be met in pathological voicing or singing. The “Glottal Disturbogram’s” principles and related features also suit similar applications such as the acoustics of some families of musical instruments. Disturbogram’s computational and display characteristics are presented with the use of both synthetic glottal patterns and real signals obtained from subjects with voice disorders. Results show that Disturbogram may efficiently discriminate and quantify perturbation types, offering a valuable tool in clinical or laboratory investigation of both voice disorders and normal voicing types.

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Arterial hypertension in diabetes mellitus: from theory to clinical practice

C. Sampanis, C. Zamboulis

Abstract

Diabetes mellitus and arterial hypertension are two common diseases that often coexist. Patients with diabetes have much higher rate of hypertension than that in general population. The co-existence of these disorders appears to accelerate microvascular and macrovascular complications and greatly increases the cardiovascular risk, risk of stroke and end stage renal disease. Arterial hypertension is clearly related to nephropathy in subjects with type 1 diabetes. In patients with type 2 diabetes insulin resistance seems to play a pivotal role in the pathogenesis of hypertension. Several well designed randomized controlled trials have provided evidence that patients with diabetes will benefit from a more aggressive treatment of hypertension. This benefit is seen at blood pressure level < 130/80 mmHg. Mopreover, most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals. Angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, diuretics, ?�-adrenoreceptor blockers and calcium- channel blockers are all effective antihypertensive agents in type 2 diabetes mellitus and no comparative trial showed the superiority of any particular class in either lowering blood pressure or reducing cardiovascular morbidity and mortality. On the basis of experimental arguments and clinical observations that have shown their apparent superiority in slowing diabetic nephropathy, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers are preferred as the first choice alone or in combination with diuretics. Second choice should be long-acting calcium-channel blockers or cardioselective ?� blockers. Clinicians should be aware of the need for aggressive treatment of hypertension and spend more time in order to provide maximal benefit to the treatment of diabetes mellitus and hypertension.

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Metabolic syndrome and sleep apnea

I. Kostoglou-Athanassiou, P. Athanassiou

Abstract

Metabolic syndrome is a disorder characterized by abdominal obesity, hypertension, increased triglycerides, decreased HDL cholesterol and increased blood glucose. Accumulating evidence strongly indicates that insulin resistance and an increased amount of abdominal fat are the pathogenic factors for the characteristics of metabolic syndrome. The metabolic syndrome is characterized by an increased risk for the development of cardiovascular disease and type 2 diabetes mellitus. Studies indicate that sleep apnea may be a manifestation of the metabolic syndrome. It has also been suggested that the metabolic syndrome or ???syndrome X??� should also comprise obstructive sleep apnea and should then be called syndrome ???Z??�. It appears that obstructive sleep apnea and the metabolic syndrome are characterized by the same pathophysiologic environment, which increases the risk for the development of cardiovascular disease. The increased amount of visceral fat and the accompanying insulin resistance seem to be the main characteristics responsible for the development of obstructive sleep apnea and the metabolic syndrome.

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Contrast media-induced nephropathy: case report and review of the literature focusing on pathogenesis

G. Efstratiadis, P. Pateinakis, G. Tambakoudis, A. Pantzaki, D. Economidou, D. Memmos

Abstract

Contrast media administration during diagnostic and invasive procedures in high risk patients for nephrotoxicity is a common problem in clinical practice. The mechanisms involved in renal function impairment after contrast media administration are not precisely known but are intensively investigated, and new data have emerged in the literature lately. We present the case of a 72-year old male patient with diabetic nephropathy to whom a new generation iso-osmolar contrast medium (iodixanol) was administered during intravenous pyelography. Due to the contrast agent administration, the patient developed irreversible acute renal failure and became dialysis-dependent. This case suggests that even new generation contrast media (including iodixanol) may be severely nephrotoxic, when administered to high risk patients. Additionally we review the complex mechanisms involved in pathogenesis of contrast media nephrotoxicity.

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Normal peak nasal inspiratory flow rate values in Greek children and adolescents

Hippokratia 1997, 1(2):111-113

A. Papachristou, E. Bourli, D. Aivazi, E. Futzila, Th. Papastavrou, Th. Konstandinidis, E. Maratou, G. Ilonidis, V. Aivazis

Abstract

Background and aim: Peak Nasal Inspiratory Flow Rate (PNIFR) is a clinical trial that has been instituted in clinical practice in order to determine the extent of nasal airway patency and it is used to assess the degree of nasal obstruction.This study attempts to provide tables referring to normal values of PNIFR in children and adolescents. Patients and Methods: Three thousand one hundred and seventy pupils aged between 5 ??? 18 years, were selected to enter the study. Children with acute or chronic upper airway obstruction, such as acute obstructive pulmonary disease or allergic rhinitis and children below the 3rd percentile for weight and/or height were excluded from the study. All children that took part in the study were subjected to PNIFR measurements by using a portable Youlten Peak Flow meter. Results: A continuous increase of PNIFR values for boys and girls in relation to age increase was recorded. PNIFR values were higher in boys compared to girls and this difference was statistically significant until the age of 12. Conclusion: Normal ranges for PNIFR standards are of great importance for the study of nasal patency, evaluation of the degree of nasal obstruction and application of treatment. This is the first time that a detailed description of PNIFR standards becomes available for the Greek population of children and adolescents.

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Stroke and conditions that mimic it: a protocol secures a safe early recognition

A. Hatzitolios, C. Savopoulos, G. Ntaios, F. Papadidaskalou, E. Dimitrakoudi, M. Kosmidou, M. Baltatzi M, D. Karamitsos

Abstract

Objective: Certain disorders may be falsely diagnosed as stroke. We examined the efficacy of the diagnostic protocol that is followed in our stroke unit and was designed in order to early differentiate more efficiently between stroke and conditions that mimic it. Methods - Patients: Three hundred sixty-two elderly patients (196 male, 166 female with average age 74.56 years), who were hospitalized at our stroke center between January of 2005 and June of 2007 and diagnosed at admission as stroke patients, were retrospectively studied in order to investigate if the final diagnosis agreed with the initial diagnosis of stroke on admission.
Our diagnostic protocol included medical history of the patient, assessment of state of consciousness, blood pressure, electrocardiogram, complete blood cell count (hematocrit/hemoglobin, leukocytes, platelets), clotting mechanism (prothrombin time, activated partial thromboplastin time), glucose, electrolytes (Na, K, Ca), renal (blood urea nitrogen, creatinine) and liver function (SGOT, SGPT), as well as imaging methods like chest X-Ray and brain CT scan. Results: In 95% of patients, the final diagnosis agreed with the initial diagnosis of stroke at admission. According to final diagnosis, 344 (95%) of them had stroke -either hemorrhagic or ischemic-, while from the rest 18 (5%), 12 (66.7%) were found to have metastatic neoplasm of brain, 3 (18.7%) had primal tumour of brain, whereas 3 (18.7%) suffered from other diseases (respiratory infection, meningoencephalitis, thyrotoxicosis). The principal symptoms of the conditions that mimicked a stroke were: aphasic disturbances (27.3%), dizziness/fainting (27.3%), headache/diplopia (11.1%), dysarthria (11.1%), hiccup and/or swallow disturbances (5.6%). Conclusion: Our diagnostic protocol seems to ensure a high degree of differential diagnosis between stroke and conditions that mimic it.

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Classification criteria for neuropsychiatric systemic lupus erythematosus: Do they need a discussion?

S. Monov, D. Monova

Abstract

Background: At the current stage, the criteria for making the diagnosis of SLE (ARA, 1982) include only two neuropsychiatric manifestations: seizures and psychoses. In view of the need for early detection of the lesions of the nervous system, we set ourselves to the task of developing an approach for making the diagnosis of NPSLE (neuropsychiatric SLE) on the basis of criteria with high sensitivity and specificity.
Methods: In view of determining the type and incidence of the lesions of the nervous system (NS), clinical, laboratory, and instrumental examinations were performed within the period from 1998 to 2006 in 225 patients with SLE. Depending on the specific features of the clinical course, these patients were divided into three groups: with clinically manifested lesions of NS; without clinically manifested lesions of NS; and with incomplete SLE. Results and conclusions: The results from the performed examinations showed a high percentage (64.44%) of neuropsychiatric lesions in the patients with SLE. According our results, NPSLE diagnosis should be made in the presence of at least one indicator from the first group of criteria (seizures, psychosis, cerebrovascular event, lesion of cranial nerves, motor disturbances, quantitative alterations of consciousness) and at least two indicators from the second group of criteria (cognitive dysfunction, headache due to lupus, peripheral neuropathy, MRI changes, EEG changes, ENMG changes, positive aRPA, positive aPL) after ruling out other causes (except for SLE) for their occurrence.

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Tension free vaginal tape underneath bladder base: does it prevent cystocele recurrence?

T. Tantanasis, C. Giannoulis, A. Daniilidis, K. Papathanasiou, MD. Loufopoulos A, J. Tzafettas

Abstract

Objective: The target of the current prospective study was to assess the effectiveness of the polypropylene tapes in preventing recurrence of cystocele formation when placed underneath the bladder base.
Materials and Methods: Twenty-two Caucasian women, predominantly postmemopausal with marked descent of the anterior, middle and/or posterior pelvic segment, participated in the study. Vaginal reconstructive surgery including anterior colporrhaphy and Kelly placation, posterior colpoperineorrhaphy and/or hysterectomy, was undertaken in all subjects. The polypropylene tape was placed not under the midurethra, as often performed in stress urine incontinence (SUI) cases, but underneath the bladder base as an adjunct to the anterior colporrhaphy sutures. The postoperative follow up lasted 2 years and was carried out every 4 months. The assessment of the anatomic result included evaluation of the operated sites and the position of the tapes inserted on clinical grounds and after perineal sonography. Urodynamic
assessment was performed in the presence of urinary incontinence. Results: In all patients the postoperative correction of the anterior vaginal wall was sufficient, 14 subjects did not present genitourinary symptoms and therefore were considered as cured; three patients were designated as improved because despite sufficient anatomic correction of the anterior vaginal segment they reported urinary incontinence symptoms. Retropubic haematoma occurred in 1 patient, transient urge incontinence in 1, transient stress incontinence in 1, and persistent stress incontinence also in 1. There was no erosion of the tape noticed. Mean residual urine was 30 ml, mean bladder base distance to the inferior edge of the symphysis pubis was 1.2 cm and the mean total vaginal length was 7 cm. Conclusion: Despite the relative short follow up period and the limited number of patients enrolled, we conclude from our study that the use of polypropylene tapes as an adjunct for fortification of the anterior pelvic segment could provide an option in preventing recurrence of cystocele formation.

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A four - year retrospective study of amniocentesis: one centre experience

A. Daniilidis, H. Karydas, V. Zournatzi, T. Tantanasis, C. Giannoulis, J. Tzafettas

Abstract

Aim: Monitor the performance of the amniocentesis procedure for prenatal diagnosis and particularly the acquisition of results (time to get, success in getting them). Materials and Methods: This is a retrospective review of case notes of all pregnant women undergone amniocentesis in our department during the period 2002-2005. Two main operators performed the procedure, using 22 gauze needle usually and 20 gauze should longer needle was needed. Sevendy three patients undergone amniocentesis. The reasons for having this procedure were: increased risk for Down syndrome in 68% (50/73), maternal request in 24% (18/73), suspicious ultrasound findings in 4% (3/73) and family history in 3% (2/73). Maternal age ranged from 20 to 45 years and the gestation time that amniocentesis was performed was 15 to 23 weeks. Fluorescence in situ hybridization (FISH) and culture were used in order to obtain karyotype results. Results: In 92% (67/73) of cases one needle pass was needed. FISH and culture were performed in 96% (70/73) of cases, FISH only in 3% (2/73) and culture only in 1% (1/73). The chromosome results were normal in 93% (68/73) of cases, Down???s syndrome in 4% (3/73) and Edwards syndrome in 3% (2/73). The outcome of pregnancies was: live births in 89% (65/73), stillbirths at 32 weeks and 35 weeks in 3% (2/73), miscarriages in 1% (1/73 at 19 weeks, 3 weeks after the amniocentesis), terminations in 7% (5/73, due to chromosomal abnormalities). Sixty one women delivered at term (84%) and 6 women (8%) delivered preterm. Conclusions: The post amniocentesis rate of miscarriage is calculated at 1% in our centre. FISH analysis can relieve stress of couples by reducing the waiting time for results.

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Skin Biopsy for the diagnosis of Alport Syndrome

E. Lagona, L. Tsartsali, S. Kostaridou, A. Skiathitou, E. Georgaki, F. Sotsiou

Abstract

Alport syndrome (AS) is the most common hereditary nephritis often associated with extrarenal manifestations. It was first described by Alport on 1927. There is a primary disorder in collagen type IV which is the main component of the basement membranes. Alport syndrome is more frequently inherited as an X-linked and less commonly as an autosomal dominant or autosomal recessive trait. We describe the case of a 3-year-old boy with the X-linked variant of AS. The diagnosis was at first speculated from the child???s detailed family history and was finally confirmed by a skin biopsy. Skin biopsy is an efficient and less invasive method for the X-linked variant of the AS diagnosis.

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Detection of hereditary bisalbuminemia in a Greek family by capillary zone electrophoresis

C. Angouridaki, V. Papageorgiou, V. Tsavdaridou, M. Giannousis, S. Alexiou Daniel

Abstract

It is presented herein a case of a family, four members of which suffer from hereditary bisalbuminemia. The abnormality was initially detected in a 29-year old male, by serum protein electrophoresis (SPE), during the investigation for possible multiple sclerosis. SPE also revealed the presence of a double albumin band in sera of the patient???s sister, father and grandmother, almost confirming the inherited (genetic) form of bisalbuminemia. Possible causes related with the acquired form of bisalbuminemia were excluded for all examined individuals. SPE was performed by both automatic capillary zone electrophoresis and agaroze gel electrophoresis. All tested samples were immunofixated with special antisera, in order to exclude the presence of monoclonal fractions. Total albumin, total proteins and immunoglobulins varied in normal ranges. The relative mobility of the albumin variant was determined by a simple mixing experiment, which gave evidence of the fast-type form of inherited bisalbuminemia. This is the first report of hereditary bisalbuminemia in Greece.

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