The Diabetic foot: A global threat and a huge challenge for Greece

Hippokratia 2009; 13 (4): 199-204

N. Papanas, E. Maltezos

Abstract

The diabetic foot continues to be a major cause of morbidity, posing a global threat. Substantial progress has been now accomplished in the treatment of foot lesions, but further improvement is required. Treatment options may be classified into established measures (revascularisation, casting and debridement) and new modalities. All therapeutic measures should be provided by specialised dedicated multidisciplinary foot clinics. In particular, the diabetic foot is a huge challenge for Greece. There is a dramatic need to increase the number of engaged foot care teams and their resources throughout the country. It is also desirable to continue education of both physicians and general diabetic population on the magnitude of the problem and on the suitable preventative measures. At the same time, more data on the prevalence and clinical manifestations of the diabetic foot in Greece should be carefully collected. Finally, additional research should investigate feasible ways of implementing current knowledge in everyday clinical practice.

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Guidelines for Diagnosing and Treating Sleep related Breathing Disorders in Adults and Children (Part 2: Treatment)

Hippokratia 2009; 13(4):247 - 252

V. Tsara, A. Amfilochiou, MJ. Papagrigorakis, D. Georgopoulos, E. Liolios, C. Alexopoulou, C. Maniou, P. Kithreotis, G. Trakada, F. Synodinos, G. Vilos, P. Steiropoulos

Abstract

Obstructive Sleep Apnea Syndrome (OSAS) should be approached as a chronic disease requiring long-term multidisciplinary management. The patient should be an active participant in the decision on treatment type and taught to contribute to the management of his or her own disease.

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Brain dead donor kidneys are immunologically active: is intervention justified?

Hippokratia 2009; 13 (4): 211-215

G Vergoulas, P. Boura, G. Efstratiadis

Abstract

The improvement in the field of kidney transplantation, during the last decades, has brought kindey transplantation to the top of patient preference as the best kidney replacement therapy. The use of marginal kidney grafts, which are highly immunogenic has become common practice because of lack of kidney donors.Inflammatory activity in the kidneys after brain death is an ongoing phenomenon. The inappropriate treatment of brain dead donor may result to primary non function (PNF) of the graft, delayed graft function (DGF) or to long term graft dysfunction and shortened graft survival. Therefore correct handling of the brain dead donor is of paramount importance. The impact of various pharmacologic agents (catecholamines, glucocorticoids, carbamylated recombinant human erythropoietin, recombinant soluble P-selectin glycoprotein ligant, heme oxygenase-1, carbon monoxide, and mycophenolate mofetil) on the immunogemicity of brain dead donor kidneys is discussed.

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Genetics of Polycystic Ovary Syndrome

Hippokratia 2009; 13 (4): 216-223

N. Prapas, A. Karkanaki, I. Prapas, I. Kalogiannidis, I. Katsikis, D. Panidis

Abstract

Polycystic ovary syndrome (PCOS) is a syndrome involving defects in primary cellular control mechanisms that result in the expression of chronic anovulation and hyperandrogenism. This syndrome has been for many years one of the most controversial entities in gynecological endocrinology.Polycystic ovary syndrome has been proven to be a familial condition. Although the role of genetic factors in PCOS is strongly supported, the genes that are involved in the etiology of the syndrome have not been fully investigated until now, as well as the environmental contribution in their expression.The heterogeneity of the syndrome entertains the mystery around this condition which concerns thousands of infertile women worldwide. Some genes have shown altered expression suggesting that the genetic abnormality in PCOS affects signal transduction pathways controlling steroidogenesis, steroid hormones action, gonadotrophin action and regulation, insulin action and secretion, energy homeostasis, chronic inflammation and others. The present review of the contemporary literature constitutes an effort to present all the trends in the current research for the etiology of polycystic ovary syndrome.

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Renal fibrosis

Hippokratia 2009; 13(4):224-228

G. Efstratiadis, M. Divani, E. Katsioulis, G. Vergoulas

Abstract

Tubulointerstitial renal fibrosis, characterized as a progressive detrimental connective tissue deposition on the kidney parenchyma, appears to be a harmful process leading inevitably to renal function deterioration, independently of the primary renal disease which causes the original kidney injury. Epithelial to Mesenchymal Transition (EMT) of tubular epithelial cells which are transformed to mesenchymal fibroblasts migrating to adjacent interstitial parenchyma constitutes the principal mechanism of renal fibrosis along with local and circulating cells. Proteinuria as well as hypoxia is included among the main mechanisms of EMT stimulation. TGFβ-1 through the SMAD pathway is considered as the main modulator regulating the EMT molecular mechanism, probably in cooperation with hypoxia inducible factors. Hepatocyte Growth Factor (HGF) and Bone Morphogenetic Factor-7 (BMF-7) are inhibitory to EMT molecules which could prevent in experimental and clinical level the catastrophic process of interstitial fibrosis. Interesting data emerge indicating that HGF and BMF-7 administration prevents the peritoneal fibrosis of mesothelial cells.

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Impact of computer use on children's vision

Hippokratia 2009; 13(4):230-231

N. Kozeis

Abstract

Today, millions of children use computers on a daily basis. Extensive viewing of the computer screen can lead to eye discomfort, fatigue, blurred vision and headaches, dry eyes and other symptoms of eyestrain. These symptoms may be caused by poor lighting, glare, an improper work station set-up, vision problems of which the person was not previously aware, or a combination of these factors. Children can experience many of the same symptoms related to computer use as adults. However, some unique aspects of how children use computers may make them more susceptible than adults to the development of these problems. In this study, the most common eye symptoms related to computer use in childhood, the possible causes and ways to avoid them are reviewed.

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Does prostate specific antigen density correlates with aggressiveness of the prostate cancer?

Hippokratia 2009; 13 (4): 232-236

S. Saidi, V. Georgiev, S. Stavridis, D. Petrovski, S. Dohcev, L. Lekovski, Z. Popov, S. Banev, G. Spasovski

Abstract

Background: As already documented, a high prostate specific antigen in men with normal size of prostate gland is more likely to be associated with an aggressive cancer as compared to others with the same prostate specific antigen and a large gland size. In this retrospective study we tested the association between Prostate Specific Antigen Density (PSAD) and tumor aggressiveness in patients with clinically localized Prostate Cancer (PCa) surgically treated by radical prostatectomy. Methods: We evaluated data from patient?s records in a cohort of 72 patients who underwent radical prostatectomy between January 2000 and June 2007. PSAD was calculated as ratio between the preoperative total prostatic specific antigen (PSA) in nanograms per milliliter with the prostate weight (PW) of prostatectomized specimen in grams or prostate volume measured with ultrasound (US). The patients were stratified into four PSAD categories: 0.1-0.15, 0.16-0.20, 0.21-0.5 and greater than 0.51 ng/ml/gr. Parameters that were included into analysis were: PSA, measurement of the prostate volume by ultrasound (preoperatively) and prostate weight, pathological tumor stage, Gleason sum, Gleason grade, metastatic lymph nodes, seminal vesicle involvement and organ confine disease (postoperatively). Worsening of the clinicopathological properties was defined as aggressiveness. Results: There was a significant correlation between US-PSAD and PW-PSAD (p<0.001). In US-PSAD categories the statistic tests found significant correlation with the primary tumor (R=0.303, p<0.01), metastatic lymph nodes (R=0.331, p<0.01), and the organ confine disease (R=0.296, p<0.05). The PW-PSAD categories correlated significantly with the pathologic findings from other parameters. Hence, a statistically significant correlation was found with Gleason sum (R=0.246, p<0.05), Gleason grade (R=0.234, p<0.05), primary tumor (R=0.285, p<0.05), metastatic lymph node (R=0.287, p<0.05) and organ confine disease (R=0.303, p<0.01). Conclusions: Prostate specific antigen density measurement is useful tool for the assessment of the degree of aggressiveness in clinically localized prostate cancer, and further investigation regarding its possible use as a prediction marker is justified.

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Coagulation factors as biological risk markers of endothelial dysfunction. Association with the thrombotic episodes of chronic hemodialysis patients

Hippokratia 2009; 13(4):237-241

A. Sioulis, P. Malindretos, A. Makedou, P. Makris, D. Grekas

Abstract

Background and aim: The aim of our study was to assess the coagulation factors as endothelial dysfunction markers and prospectively their association with thrombotic episodes in chronic hemodialysis patients.Patients and Methods: Fifty-four randomly selected patients on chronic hemodialysis (HD), 34 men and 20 women were included in this study. Their mean age was 56 years and the mean hemodialysis duration was 53.08�61.92 months.The variations of tissue factor pathway inhibitor (TFPI), thrombomodulin (TM) and von Willebrand factor (vWF) were studied. The above-mentioned parameters were measured before and after HD session. Low molecular weight heparin (tinzaparin) was administered to all patients during hemodialysis. The results were compared with those obtained from 20 healthy volunteer-controls, age and sex matched. After the initial assessment, all patients were followed for a period of 15 months.Results: Two patients experienced one hemorrhagic event each, regarding the upper and/or the lower gastrointestinal tract. Twenty patients showed at least one thrombotic episode. Eleven patients presented fistula thrombosis, four angina pectoris incidents and five thrombosis of the lower limbs. The rest of the patients did not experience any clinical symptomatology that could be attributed to coagulation disorders. Parameter differences between patients and controls were statistically significant (p<0.005 for TFPI and p<0.001 for TM and vWF) and were improved after hemodialysis session. The age and the elevated levels of the vWF were found to be significantly different (p<0.03 and p<0.02 respectively) between the groups of patients who experienced or not thrombotic episodes.Conclusions: Coagulation factors TFPI, TM, and vWF are increased in hemodialysis patients and the clinical disorders are mainly thrombotic episodes. The age of patients and the elevated levels of vWF are associated with the thrombotic incidents. Hemodialysis contributes in the improvement of these coagulation factors, which could be considered as biological risk markers of endothelial dysfunction in chronic HD patients.

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Acute respiratory admissions in Thessaloniki, Greece: 14-year follow-up

Hippokratia 2009; 13(4):242-246

E. Hatziagorou, F. Kirvassilis, S. Saraphidou, M. Katsara, R. Valeri, M. Emporiadou, C. Magnisali, J. Tsanakas

Abstract

Background: Acute exacerbations of respiratory diseases are a common cause of hospitalization among infants and children. Aim: To assess the epidemiological characteristics of asthma, bronchiolitis and croup among hospitalized children in Thessaloniki, from 1990 to 2003 included.Methods: Data from the patient registry with discharge diagnosis ?asthma?, ?bronchiolitis? and ?croup? were analyzed retrospectively, in five Paediatric Departments of Thessaloniki. Age and sex of the patients, as well as the month of admission were taken into consideration.Results: A total of 8762 admissions of children (aged 3 months - 14 years) with the diagnosis of ?asthma?, ?bronchiolitis? and ?croup?, were identified. Sex distribution was 65.86% males (64.86% bronchiolitis, 65.26% asthma and 70.31% croup). Asthma admissions decreased by 53.65%, croup admissions decreased by 4.73%, while bronchiolitis admissions increased by 25.03%, during the study period.A clear seasonal variation was found in all the three diseases, with the lowest incidence during summer months.Moreover there were two peaks for asthma (one during spring and a second during autumn), one peak for bronchiolitis (during winter ? early spring) and one peak for croup (during autumn). Conclusions: Paediatric asthma and croup admissions have declined during the last 14 years, in contrast with bronchiolitis admissions, which showed an increased tendency.More frequent use of inhaled steroids and induction of asthma education programs may have contributed to decreasing asthma admission rates.

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Hepatitis C and liver transplantation

Hippokratia 2009; 13 (4): 211-215

G. Tsoulfas, I. Goulis, D. Giakoustidis, E. Akriviadis, P Agorastou, G Imvrios, V Papanikolaou

Abstract

Cirrhosis due to chronic hepatitis C is the leading indication for liver transplantation in Europe, United States and Japan. Reinfection after liver transplantation is universal and chronic liver disease develops in at least 70% of patients at 3 years, with an accelerated course compared to the nontransplant setting. These facts underscore the need for a better understanding of hepatitis C infection and the various treatment modalities. This paper attempts a brief review of the scope of the disease, as well as the different treatment modalities, with special emphasis given to orthotopic liver transplantation.

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