H1N1 Influenza A infection

Hippokratia 2009; 13 (3): 135-138

J. Dotis, E. Roilides

Abstract

The 2009 flu outbreak in humans, known as ?swine influenza? or H1N1 influenza A, refers to influenza A due to a new H1N1 strain called swine-origin influenza virus A (S-OIV). The new swine flu virus is actually a genetic mixture of two strains, both found in swine, of unknown origin. S-OIV can be transmitted from human to human and causes the normal symptoms of influenza. Prevention of swine influenza spread among humans includes use of standard infection control measures against influenza and constitutes the main scope of World Health Organization. For the treatment of S-OIV influenza oseltamivir and zanamivir are effective in most cases. Prophylaxis against this new flu strain is expected through a new vaccine, which is not available yet. Worldwide extension of S-OIV is a strong signal that a pandemic is imminent and indicates that response actions against S-OIV must be aggressive.

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Spontaneous haematoma of the pharynx due to a rare drug interaction

Hippokratia 2009; 13 (3): 175-177

S. Triaridis, G. Tsiropoulos, D. Rachovitsas, G. Psillas, V. Vital

Abstract

Spontaneous haemorrhage is a well known complication of oral anticoagulation therapy. Various sites of bleeding have been reported in the literature, most commonly being the gastrointestinal tract, genitourinary system and central nervous system. Spontaneous haematoma is rarely reported to involve the upper aerodigestive tract, being potentially a life threatening condition. We report a case of a 67 year-old female patient who developed spontaneous heamatoma of the upper aerodigestive tract as a consequence of a rare interaction between acenocoumarol and clindamycin. Reversal of anticoagulation, careful observation, and when necessary prompt intervention to secure the airway are the main aspects of management. We highlight the need for a thorough evaluation of patients who develop new painful or other symptoms while being on anticoagulation therapy.Clinicians should be highly alerted as these could potentially be manifestations of haemorrhagic complications.

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Vascular calcification and metabolic acidosis in end stage renal disease

Hippokratia 2009; 13 (3): 139-140

D. Yonova

Abstract

Cardiovascular manifestations are very common in patients with end stage renal disease and those undergoing dialysis treatment. One of the factors, causing cardiovascular disorders due to mineral metabolism disturbances in uremia is the appearance of cardiovascular calcification. The precise mechanism of the mineral metabolism disturbances acting through the existing metabolic acidosis in chronic renal failure is not yet clarified. The influence of acidosis is a complex one, acting as a stimulator of the solubility of Ca-P deposits, a suppressor of parathyroid secretion, an inhibitor of some osteogenic enzymes, a blocker of formation of bone matrix, a modulator of the up-regulation of Pit-1 and finally as a blocker of phosphate uptake by the arterial smooth muscle cells.

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Current evaluation of the dysphagic patient

Hippokratia 2009; 13 (3): 141-146

PD Karkos, S Papouliakos, CD Karkos, EG Theochari

Abstract

Dysphagia is a symptom so common and diverse that is often considered as a disease in its own right. Its severity can range from a trivial problem to a lethal condition. It can seriously compromise the quality of life of affected patients, therefore management should be prompt. The implications of dysphagia in healthcare costs are immense. Assessment of dysphagic patients is based on a comprehensive history and thorough examination. In the present review we discuss physiology, aetiology, diagnosis and management emphasizing the role of a multidisciplinary team approach. We also focus on the role of fibreoptic endoscopic evaluation of swallowing which revolutionized over recent years the assessment of the dysphagic patient.

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Open tibial fractures. Are children small adults?

Hippokratia 2009; 13 (3): 147-153

NE. Gougoulias, A. Khanna, N. Maffuli

Abstract

Open tibial fractures in adults have been extensively studied. In children, however, only a small number of case series provide data on management and outcome of these injuries. It is not clear whether open tibial fractures in children ?behave? in a similar fashion to those in adults, and clear guidelines regarding their management do not exist. Primary wound closure after irrigation does not increase infection rates in low grade open tibial fractures. Cast is an effective method for fracture stabilization in stable fractures. External fixation is usually used in patients with significant soft tissue injury, and elastic intramedullary nailing is an alternative. Age over 10 years and open fracture grade III appear to be significant prognostic factors. Complication rates are not unremarkable and long-term studies are required to investigate their consequences. Children over 10 years should probably be managed as adults. Further research is needed to evaluate the effectiveness of different fracture management methods.

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Factors affecting results of treatment of Hypopharyngeal Carcinoma

Hippokratia 2009; 13 (3): 154-160

D. Milisavljevic, M. Stankovic, M. Zivic, M. Popovic, Z. Radovanovic

Abstract

Objective: A retrospective review of patients with malignant neoplasms of the hypopharynx treated with combined surgery and radiotherapy is presented to highlight the results of treatment and the factors of treatment success for this malignant disease.
Patients and Methods: Between 1995 and 2004 at the University ORL Clinic Nis 89 patients with malignant neoplasms of hypopharynx (85 males, 4 females, and age ranging from 44 to 77 years) were treated. In the 89 patients (stage I, n = 4; stage II, n = 3; stage III, n = 34; stage IV, n = 48), the sites of origin were pyriform sinus (n = 75), postcrycoid (n = 8),posterior pharyngeal wall (n = 3) and superior hypopharynx (n = 3).Results: Laryngeal preservation surgery was achieved in 11.2% of patients, while 88.8% had laryngectomy with partial or total pharyngectomy. Pyriform sinus was the most common site of origin of hypopharyngeal carcinoma in 84.3%. Totally 93% of patients had neck metastases, and tumors extended beyond the hypopharynx in 41.6% of patients. TNM stage was highly significant parameter of outcome. Five year survival was 100% for stage I, 66.6% for stage II, 53.9% for stage III, and 33.3% for stage IV. Residual disease (5.6%) and recurrent disease (2.2%) were low. Postoperative fistula developed in 16.8% of patients, and in 60% it was closed successfully using local flaps, while in 40% pectoralis flap was needed. Localization of disease was also an important factor of survival. Retrocrycoid carcinoma resulted in very poor survival rate (12.5%), high residual disease, lymph node metastasis, and pharyngocutaneous fistula formation.
Conclusion: Localization and TNM stage are highly significant factors for clinical course, treatment, and outcome of hypopharyngeal carcinoma.

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The influence of renal manifestations to the progression of autosomal dominant polycystic kidney disease

Hippokratia 2009; 13 (3): 161-164

A. Idrizi, M. Barbullushi, E. Petrela, S. Kodra, A. Koroshi, N. Thereska

Abstract
Background: Renal stones, urinary tract infections (UTI) and gross hematuria (GH) are the most important renal manifestations of autosomal dominant polycystic kidney disease (ADPKD). They are not only common, but are also frequent cause of morbidity, influencing renal dysfunction.The aim of this study was to evaluate the frequency of these manifestations in our patients with ADPKD and their impact on renal function.Methods: One hundred eighty ADPKD patients were included in the study. Subjects were studied for the presence of UTI, gross hematuria frequency and responsible factors of nephrolithiasis. Survival times were calculated as the time to renal replacement therapy or time of serum creatinine value up to 10 mg/dl. Kaplan-Meier product-limit survival curves were constructed, and log rank test was used to compare the survival curves.Results: Kidney stones were present in 76/180 (42% of pts). The stones were composed of urate (47%) calcium oxalate (39%), and other compounds 14%. UTI was observed in 60% (108 patients). Patients treated with urinary disinfectants had a significant lower frequency of urinary infection (p<0.001) and hematuria (p<0.001) after one year than untreated patients. Gross hematuria was present in 113 patients (63%). In 43 patients hematuria was diagnosed before age 30 (38%), while in 70 patients it was diagnosed after age 30 (62%).Conclusions: UTI is frequent in our ADPKD patients. The correct treatment of UTI decreases its frequency and has beneficial role in the rate of progression to renal failure in ADPKD patients. Patients with recurrent of gross hematuria may be at risk for more severe renal disease.

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DNA repair enables sex identification in genetic material from human teeth

Hippokratia 2009; 13 (3): 165-168

L. Kovatsi, D. Nikou, S. Triantaphyllou, SN. Njau, S. Voutsaki, S. Kouidou

Abstract

Background: The purpose of this study was to test the effectiveness of a DNA repair protocol in improving genetic testing in compromised samples, frequently encountered in Forensic Medicine.Methods: In order to stretch the experiment conditions to the limits, as far as quality of samples and DNA is concerned,we tried the repair protocol on ten ancient human teeth obtained from an equal number of skeletons from a burial site in Lerna, Middle Helladic Greece (2100 - 1700 BC). For these samples, sex was previously determined morphologically, serving as a reference to compare our molecular data with. The samples were analysed using the DNA amelogenin sex test assay prior and after DNA polymerase repair. For every individual, two molecular sex determinations were obtained by visualising PCR products on an agarose gel.Results: DNA repair enabled genetic testing in these samples. Successful amplification of the amelogenin gene was obtained only from the repaired DNA in eight out of ten samples. Prior to the repair treatment, none of these samples yielded any PCR products, thus attesting to the authenticity of the amplified sequence. The concordance between morphological and molecular analysis was in reasonable agreement (71%).Conclusions:These results reveal the impact of the repair process in studying single copy genes from low quality DNA.This protocol could facilitate molecular analysis in compromised samples, encountered in forensic medicine, as well as enable genetic studies in ancient remnants.

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Unusual findings in inguinal hernia surgery: Report of 6 rare cases

Hippokratia 2009; 13 (3): 169-171

K. Ballas, Th. Kontoulis, Ch. Skouras, A. Triantafyllou, N. Symeonidis, Th Pavlidis, G. Marakis, A. Sakadamis

Abstract

Background and aim: To present our experience with unexpected findings during hernia surgery, either unusual hernial contents or pathologic entities, like neoplastic masses, masquerading as a hernia.Patients and methods: We studied retrospectively 856 patients with inguinal hernia who were admitted to our surgical department over a 9-year period. In addition, our study included patients complaining of inguinal protrusion, even without a definitive diagnosis of inguinal hernia upon admission. Results: Five patients presented with unusual hernial contents. Three of them had a vermiform appendix in their sac.Acute appendicitis (Amyand?s hernia) was found in only one case. One patient had epiploic appendagitis related with a groin hernia. Moreover, an adult woman was diagnosed with ovarian and tubal inguinal hernia. Finally, we report a case of a massive extratesticular intrascrotal lipoma, initially misdiagnosed as a scrotal hernia. Conclusion: a hernia surgeon may encounter unexpected intraoperative findings. It is important to be prepared to detect them and apply the appropriate treatment.

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A case of crescentic IgA nephropathy treated with prednisolone and cyclophosphamide

Hippokratia 2009; 13 (3): 172-174

E. Sengul, T. Eyileten, A. Ozcan, Mi. Yilmaz, M. Yenicesu

Abstract

IgA nephropathy (IgAN) is the most common glomerulonephritis in the world, and currently is known to be an important cause of end stage renal disease (ESRD). Hypertension, proteinuria more than 1 g/d, and the presence of severe lesions on initial renal biopsy such as crescents and interstitial fibrosis are the most significant predictive factors for progression to ESRD. Despite its prevalence and clinical importance, there is no consensus for the treatment of patients with risk factors for a worse prognosis. Our aim is to describe here a case of crescentic IgAN, and to emphasize the effect of immunosupressive treatment.

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Successful thrombolysis of right atrial and ventricular thrombi in a patient with massive pulmonary embolism

Hippokratia 2009; 13 (3): 178-180

I. Vogiatzis, I. Dapcevic, V. Sachpekidis, P. Stafylas, A. Sidiropoulos, S. Pittas, V. Tsangaris

Abstract

Right sided heart thrombi may develop within the right heart chambers or they may be peripheral venous clots that on their way to the lungs, accidentally lodge in a patent foramen ovale, tricuspid chordae or Chiari?s network. Type A thrombi have a worm-like shape and are extremely mobile. These pleomorphic thrombi are mainly localized in the right atrium, frequently move back and forth through the tricuspid orifice and may cause cardiovascular collapse when entrapment occurs. Type B thrombi attach to the atrial or ventricular wall indicating that they are probably of local origin. We describe the case of a middle age man (48 years old) with no cardiovascular history and a massive pulmonary embolism where transthoracic echocardiography revealed many type A thrombi in both right atrium and ventricle. He presented with acute dyspnea, diaphoresis and hemodynamical instability. He was treated with thrombolysis and after three hours was greatly improved and the thrombi were disappeared. After ten days of hospitalization he was discharged. Thrombi were originated in the popliteal region of the inferior vena cava of both legs and were totally treated.

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Severe exertional dyspnea as the prime manifestation of acute cytomegalovirus infection in an immunocompetent adult

Hippokratia 2009; 13 (3): 181-183

ED. Pagourelias, A. Papageorgiou, A. Basayannis, VG. Athyros, A. Karagiannis, P. Zorou, P. Geleris

Abstract

Primary cytomegalovirus infection is rare among immunocompetent hosts. We present a case of acute cytomegalovirus infection in a young immunocompetent female with pulmonary and hepatic involvement, admitted to our department due to severe exertional dyspnea. Patient?s symptoms were completely atypical. Ganciclovir was administered succeeding complete clinical and laboratory signs?s resolution.

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Invasive infection caused by Pseudallescheria boydii in an immunocompetent patient

Hippokratia 2009; 13 (3): 184-186

E. Bibashi, GS. De Hoog, E. Kostopoulou, M. Tsivitanidou, J. Sevastidou, P. Geleris, Working Group: Dascalopoulou-Vlachogianni E, Nikolopoulos I, Kastanakis E, Vagiakis E, Ter

Abstract

Pseudallescheria boydii is a saprophytic fungus frequently isolated from agricultural soil and polluted water. Disseminated and invasive infections with this organism are seen primarily in the immunocompromised host. We present an unusual case of invasive P. boydii infection in an immunocompetent patient admitted to our hospital with clinical, laboratory and ECG findings of a possible acute myocardiac infarction. Six hours after admission without treatment with thrombolytic agents she presented with a right hemiparesis and loss of consciousness; a CT scan showed a cerebral hemorrage. She was treated with dexamethasone i.v. 32 mg per day. She was not incubated. Two blood cultures taken the 15th and 16th day of hospitalization, respectively, revealed a filamentous fungus which was identified by CBS as P. boydii. The pathologic examination of one nodule showed hyphae of fungi. Despite the administration of amphotericin B the patient died one week later.

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Guidelines for Diagnosis and Treatment of Sleep-related Breathing Disorders in Adults and Children.Definition and classification of sleep related breathing disorders in adults. Different types and indications for sleep studies (Part 1)

Hippokratia 2009; 13 (3): 187 - 191

E. Koutlas, L. Nikolaidou-Tokalaki, G. Zacharakis

Abstract

Guidelines on diagnosis and treatment of sleep-related breathing disorders in adults and children were introduced by the Hellenic Society of Sleep Disorders Working Group in an attempt to fill a major gap in current medical practice in Greece. They consist of the theoretical ground followed by practice recommendations regarding the diagnostic and therapeutic procedures that are currently accepted for the individual management of adults and children.The guidelines are divided into three parts. The first part entitled ?Definition and classification of sleep-related breathing disorders in adults. Different types and indications for sleep studies? refer to different syndromes related to breathing disorders during sleep such as: Central Apnea Syndromes, Cheyne-Stokes Respiration, Obstructive Sleep Apnea Syndrome, Upper Airway Resistance Syndrome, and Alveolar Hypoventilation Syndrome. In addition, major types of sleep studies such as: Full polysomnography, limited sleep study, attended sleep study, unattended sleep study, split-night study were mentioned, along with their indications for diagnostic and therapeutic purposes.The second part entitled ?Treatment of Obstructive Sleep Apnea Syndrome (OSAS) in adults? refers to different types of treatment for OSAS in adults such as Positive Airway Pressure application, oral appliances and surgical treatment. Different types of Positive Airway Pressure devices were presented, along with benefits related to their application. Finally, the issue of compliance to CPAP use is being addressed in this chapter.The third part entitled ?OSAS in children: Diagnosis and treatment? refers to Obstructive Sleep Apnea Syndrome in children. Clinical features, pathogenesis, diagnosis and treatment are also mentioned.The events leading to the formation of these guidelines are the following: First, a meeting in Athens (February 2008), where topics and committees were selected; later on a consult in Patras (June 2008), where texts were distributed among members and the final acceptance took place in Alexandroupolis (November 2008). The whole process and the final presentation were under supervision and acceptance of the Executive Committee of HSSD.

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