The Role of Vitamin D Receptor Activation in Chronic Kidney Disease

Hippokratia 2010; 14(1):7-9

M. Cozzolino, P. Malindretos

Abstract

The death rate from cardiovascular disease for dialysis patients is much higher than the general population, regardless of age. Observational data indicate that there is a close inter-relationship between progressive renal dysfunction in patients with chronic kidney disease cardiovascular disease and mortality.Continuously evidence indicates that deficiencies in vitamin D receptor activation represents one of key players in adversely affecting cardiovascular health, as well as inducing to secondary hyperparathyroidism in chromic kidney disease patients. Vitamin D receptors are widely expressed throughout the body and modulations of vitamin D levels results in correlative regulatory effects on mineral metabolism homeostasis, cardiovascular disease, and vascular calcification. The management of SHPT has developed enormously in recent years and different drug classes are available to treat this disease. Potentially, selective VDR activators not only reduce serum parathyroid hormone levels minimizing the risk of hypercalcemia and hyperphosphatemia, but also may improve patient health, reducing the risk of cardiovascular disease.

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Erythema nodosum associated with Salmonella enteritidis

Hippokratia 2010; 14 (1): 51-53

E. Mantadakis, V. Arvanitidou, A. Tsalkidis, S. Thomaidis, A. Chatzimichael

Abstract

Background: Erythema nodosum (EN) is the most frequent type of panniculitis in childhood. Although frequently idiopathic, it may be associated with a wide variety of conditions ranging from infections, to sarcoidosis, to collagen vascular diseases to drugs.
Case report: We present an 8-year-old boy who developed EN during the course of febrile gastroenteritis due to salmonella enteritidis. He received intravenous ampicillin 150 mg/kg/day divided in equal doses every six hours for 10 days. The skin lesions gradually disappeared, and he recovered fully without sequelae.
Conclusions: Salmonellosis should be considered in the differential diagnosis of EN in children with gastrointestinal symptoms, and stool cultures should be performed when indicated.

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Systems biology in heart diseases

Hippokratia 2010; 14 (1): 10-16

GE. Louridas, IE. Kanonidis, KG. Lourida

Abstract

Systems biology based on integrative computational analysis and high technology is in a position to construct networks, to study the interactions between molecular components and to develop models of cardiac function and anatomy.Clinical cardiology gets an integrated picture of parameters that are addressed to ventricular and vessel mechanics, cardiac metabolism and electrical activation. The achievement of clinical objectives is based on the interaction between modern technology and clinical phenotype. In this review the need for more sophisticated realization of the structure and function of the cardiovascular system is emphasized while the incorporation of the systems biology concept in predicting clinical phenotypes is a promising strategy that optimize diagnosis and treatment in cardiovascular disease.

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Spondylolysis: A review and reappraisal

Hippokratia 2010; 14 (1): 17-21

E. Syrmou, PP. Tsitsopoulos, D. Marinopoulos, C. Tsonidis, I. Anagnostopoulos, PD. Tsitsopoulos

Abstract

The aim of this review was to provide of the current knowledge in pathophysiology, diagnosis and management of spondylolysis based on the authors? experience and the pertinent medical literature.Spondylolysis represents a weakness or stress fracture in one of the bony bridges that connect the upper with the lower facet joints of the vertebra. It is the most common cause of low back pain in young athletes. One-half of all paediatric and adolescent back pain in athletic patients is related to various disturbances in the posterior elements including spondylolysis. The most common clinical presentation of spondylolysis is low back pain. This is aggravated by activity and is frequently accompanied by minimal or no physical findings. A pars stress fracture or early spondylolysis are common and a misdiagnosis is often made. Plain radiography with posteroanterior (P - A), lateral and oblique views have proved very useful in the initial diagnostics of low back pain, but imaging studies such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans are more sensitive in the establishment of the diagnosis. Several treatment options are available. Surgical treatment is indicated only for symptomatic cases when conservative methods fail. The fact that early and multiple imaging studies may have a role in the diagnosis of pars lesions and the selection of the optimal treatment approaches is also highlighted.

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Radiation Synovectomy: an effective alternative treatment for inflamed small joints

Hippokratia 2010; 14 (1): 22-27

N. Karavida, A. Notopouloss

Abstract

An inflamed painful joint is one of the most common indications for the patient to be referred to a rheumatologist or an orthopedician. In relation to the aetiology, the therapeutic approach might be systemic, local or a combination of them in some cases, always with the thought of balancing risk with benefit for the patient. In all cases, independently of the cause, the goal of therapy is to improve the quality of life through the reduction of pain, improvement of mobility and preservation of function. Nuclear Medicine has to offer Radiosynoviorthesis, an effective alternative procedure for treating inflamed small joints. Various radionuclides are available for radiosynoviorthesis. Their selection depends on the size of the joint to be treated. Small joints are mainly treated with [169Er] erbium under a fluoroscopic or sonographic guidance, usually with a simultaneous instillation of a corticoid. Candidates for radiosynoviorthesis should have been under a six-month systemic treatment without encouraging results or should have undergone at least one unsuccessful intra-articular injection of a long acting glucocorticoid. Since 1973, when [169Er] erbium was firstly suggested as a therapeutic agent for radiosynoviorthesis of the finger joints, there has been quite enough experience in its? application. It has been found to be cost effective in providing long term relief of pain and deformity of the inflamed joints in comparison to other therapeutic approaches. Additionally, there is no radiation risk and can be performed on an out patient basis. Therefore it can stand as an effective alternative procedure for treating early stages of chronic synovitis in RA (rheumatoid arthritis) patients, with minor damage of the cartilage and the adjacent bones, and for synovitis secondary to inflammatory arthropathies.

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Platelet distribution width: a simple, practical and specific marker of activation of coagulation

Hippokratia 2010; 14(1): 28-32

E. Vagdatli, E. Gounari, E. Lazaridou, E. Katsibourlia, F. Tsikopoulou, I. Labrianou

Abstract

Background: Platelet indices are potentially useful markers for the early diagnosis of thromboembolic diseases. An increase in both mean platelet volume (MPV) and platelet distribution width (PDW) due to platelet activation, resulting from platelet swelling and pseudopodia formation was hypothesized.
Methods: Platelet indices (MPV and PDW) in three groups of persons, using impedance and optical technology were measured. The first group consisted of patients with established platelet activation and healthy control subjects. The second study group included pregnant women in different trimesters of pregnancy. The effect of storage time on MPV and PDW in blood samples of a third group of randomly chosen patients was also assessed.
Results: There was a significant increase in MPV (P<0.001) and PDW (P<0.001) in patients with confirmed platelet activation compared to healthy control subjects. Only PDW showed a significant increase from the first to the third trimester of pregnancy (P=0.009). Temporal changes of MPV and PDW over storage time revealed a significant increase in MPV(P<0.001), in contrast to a significant decrease in PDW (P<0.05).
Conclusion: MPV and PDW are simple platelet indices, which increase during platelet activation. PDW is a more specific marker of platelet activation, since it does not increase during simple platelet swelling.

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Respiratory function in amyotrophic lateral sclerosis patients. The role of sleep studies

Hippokratia 2010; 14 (1):33-36

V. Tsara, E. Serasli, S. Steiropoulos, A. Tsorova, M. Antoniadou, P. Zisi

Abstract

Background and aim: Respiratory function decline in association with sleep breathing abnormalities in Amyotrophic Lateral Sclerosis (ALS) patients are fully recognized as crucial manifestations in the natural course of the disease, severely affecting the prognosis. The aim of this study was to evaluate the respiratory function at daytime and during sleep in a population of ALS patients and investigate the necessity of sleep study performance for the appropriate management of the disease. Patients and methods: Twenty eight (10 male, 18 female) unselected patients with ALS, were evaluated in terms with their functional status by means of the ALS Functional Scale (ALSFSC). Baseline anthropometric measurements, pulmonary function tests and arterial blood gasses analysis were performed, as well as evaluation of patients? perception of dyspnoea. A polysomnography was performed using a multichannel ambulatory recording.
Results: Nineteen patients had sleep disordered breathing with an RDI (Respiratory Disorder Index)> 5/h (from 5.6/h to 83/h) and 10 patients had an RDI>15/h. All patients had impaired functional capacity by the ALSFSC and 11 patients (39.3%) reported mild to moderate dyspnoea. FVC was below 80% predictive value in 22 patients and in 8 patients hypoxaemia (PaO240mmHg) was present. There was no correlation found between spirometric values, maximum inspiratory and expiratory pressures and sleep study parameters. There was a significant correlation between PaCO2 and RDI (r=0.498, p<0.01), and PaO2 with nocturnal hypoxaemia (average SpO2, r=0.436,p<0.05).
Conclusions: Sleep-breathing abnormality is common in ALS patients even in the absence of documented respiratory failure. Clinical evaluation and respiratory function tests alone may not be sufficient to predict sleep disordered breathing (SDB) and nocturnal breathing assessment should be included in the evaluation of respiratory function

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Sciatic nerve crush evokes a biphasic TGF-â and Decorin modulation in the rat spinal cord

Hippokratia 2010; 14 (1): 37-41

A. Kritis, D. Kapoukranidou, B. Michailidou, A. Hatzisotiriou, M. Albani

Abstract

Background and aim: Inherent property of the motoneurons of the peripheral nervous system is their ability to recover, at least in part, upon injury. To this end different factors are expressed and are thought to play important role in the regeneration processes. These factors are diverse, and range from transcription factors and chemokines, to molecules of the extracellular matrix. Transforming growth factor beta (TGF-â) is a protein with diverse actions controlling cell growth and proliferation. In the extracellular matrix it is found bound to decorin a proteoglycan involved in cell adhesion and cell signaling. In the present study we investigate the expression of TGF-â and decorin at different time points, in the regenerating sciatic nerve of a seven day old rat, having suffered nerve crush injury, over a period of one month.
Materials and methods: To achieve this, we evoked injury to male Wistar rats by exposing and applying pressure to the sciatic nerve using watchmaker?s forceps. After that at 12h, 24h, 48h, 72h, one week, and one month intervals we investigated the gene expression of decorin using RT-PCR, and followed the expression of TGF-â molecule by immunohistochemistry in frozen sections of the L4-L5 region of the rat spinal cord.
Results: We report that both decorin mRNA and TGF-â protein exhibit a concerted, biphasic expression after 12 hours and one month having the animal suffered the nerve crush.
Discussion: Our data reveal a biphasic modulation of TGF-â protein and decorin mRNA expression at lumbar segment of the spinal cord of animals having suffered unilateral sciatic nerve crush. We postulate that their concerted expression both at an early and a late phase after the nerve injury is of importance and can be part of a repair or neuroprotective mechanism as yet unclarified.

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Ocular complications of marfan syndrome. Report of two cases

Hippokratia 2010; 14 (1): 45-47

V. Mema, N. Qafa

Abstract

Background: Marfan Syndrome occurs in 8 to 10 per 100.000 of population / year1. Ocular features of this syndrome have been extensively reported. We report two patients in the same family with miscellaneous complications of this syndrome.
Case report: Two sisters with Marfan Syndrome were examined in our clinic. They revealed severe ocular complications as bilateral spontaneous complete posterior lens dislocation, total rhegmatogenous retinal detachment, and secondary glaucoma. Combined surgical and conservative treatment was applied to both cases with relative successful results. They were also referred to cardiologist for further evaluation and management.
Conclusions: Ocular complications commonly occur in Marfan?s Syndrome. Total rhegmatogenous retinal detachment, secondary glaucoma, etc. These findings require prompt and aggressive treatment to minimize visual loss in these patients.

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Traumatic corneal flap displacement five years after Laser in situ keratomileusis

Hippokratia 2010;14 (1): 48-50

A. Grezda, V. Mema, J. Jaho, J. Dai

Abstract

Laser in Situ Keratomileusis (LASIK) is the most common surgical procedure for the correction of refractive deviations1.LASIK has been ongoing lately in our country, exclusively in private settings. This is the reason for which our clinic has no experience with LASIK procedure and complications following it. We are presenting a case of a 23 year-old female with traumatic flap displacement on the left eye, 5 years after the original LASIK operation. She was presented to our clinic on the 6th posttraumatic day. The patient was immediately operated and the flap repositioned. The case we present, is the only one treated to our clinic with such a vision-threatening complication of LASIK procedure.

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Symptomatic splenoma (hamartoma) of the spleen. A case report

Hippokratia 2010; 14 (1): 54-56

I. Tsitouridis, M. Michaelides, K. Tsitouridis, I. Davidis, I. Efstratiou

Abstract

Hamartomas of the spleen (splenomas) are very rare benign tumors composed of an aberrant mixture of normal splenic elements. Herein we present a unique case of a symptomatic non-palpable splenoma in a 64-year-old female patient presented with anemia and thrombocytopenia and we describe imaging findings in ultrasound, computed tomography and magnetic resonance imaging. To our knowledge, this is the first case of a relatively small splenic hamartoma (35 mm at histopathology) associated with thrombocytopenia and anemia that resolved completely several months after splenectomy.

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Guidelines for Diagnosing and Treating Sleep related Breathing Disorders in Adults and Children (Part 3: Obstructive Sleep Apnea in Children, Diagnosis and Treatment)

Hippokratia 2010; 14 (1): 57-62

V. Tsara, A. Amfilochiou, JM. Papagrigorakis, D. Georgopoulos, E. Liolios, A. Kadiths, E. Koudoumnakis, E. Aulonitou, M. Emporiadou, M. Tsakanikos, A. Chatzis, M. Choulakis, G. Chrousos

Abstract

Obstructive sleep apnea syndrome (OSAS) in childhood is characterized by intermittent partial or complete collapse of the upper airway (obstructive hypopnea or apnea). Airflow reduction or even cessation may be associated with lung hypoventilation and hypoxemia or compromise normal sleep architecture.

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Gitelman syndrome: First report of genetically established diagnosis in Greece

Hippokratia 2010; 14 (1): 42-44

A. Galli-Tsinopoulou, M. Patseadou, A. Hatzidimitriou, P. Kokka, E. Emmanouilidou, SH. Lin, D. Tramma

Abstract

Gitelman syndrome is an inherited renal tubular disorder characterized by hypokalemic metabolic alkalosis. It is distinguished from other hypokalemic tubulopathies, such as Bartter syndrome, by the presence of both hypomagnesemia and hypocalciuria. We report a case of Gitelman syndrome in a 10-year-old girl who presented for examination of persistent unexplained hypokalemia. She had no severe clinical symptoms but she had typical laboratory findings including hypokalemia, hypomagnesemia and normocalcemic hypocalciuria. Molecular analysis revealed a mutation in the exon 21 of the SLC12A3 gene which encodes the thiazide-sensitive sodium-chloride co-transporter expressed in the distal convoluted tubule (a guanine to adenosine substitution at nucleotide 2538). She was treated with oral potassium and magnesium supplements. This is the first report of genetically established diagnosis in Greece. Gitelman syndrome should be considered as a cause of persistent hypokalemia and genetic analysis might be a useful tool to confirm the diagnosis.

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