β-Blockers in coronary artery disease management

Hippokratia 2010; 14(4): 231-235

G E. Boudonas

Abstract

Beta-blockers are a multiform group of drugs with multiple applications in the treatment of patients with cardiovascular disease. Their adverse actions are multiple and relate mainly to the â-adrenergic receptor blockade.They are used to treat all forms of coronary disease, but especially in acute myocardial infarction and acute coronary syndromes.The administration to patients with coronary artery disease resulted in increased survival and improved QoL of these patients and therefore they are a key group of drugs for their management. However, because of side effects, they should be used with caution, especially in hemodynamically unstable patients. Therefore, the choice of the appropriate β- blocker for each patient will result in the best possible results with fewer side effects.

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Focal 6-o?-clock Nd: YAG-capsulotomy for the treatment of early onset incomplete capsular block syndrome

Hippokratia 2010; 14 (4): 277-278

N. Kozeis, Z. Gatzioufas, F. Schirra, U. Loew, B. Seitz

Abstract

We report on a patient who developed capsular block syndrome (CBS) in the early postoperative period with marked myopic shift in absence of anterior dislocation of the posterior-chamber intraocular lens (PC/IOL) and iris diaphragm. Treatment with focal 6-o?-clock Nd: YAG-capsulotomy resulted in complete visual acuity restoration. To the best of our knowledge this is the fist case of early onset CBS with significant myopic shift in absence of anterior PC/IOL dislocation, which was successfully treated with focal 6-o?-clock Nd: YAG-capsulotomy. The possible underlying pathophysiological mechanism is discussed.

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microRNAs: a newly described class of encoded molecules that play a role in health and disease

Hippokratia 2010;14 (4):236-240

K. Felekkis, E. Touvana, Ch. Stefanou, C. Deltas

Abstract

Micro RNAs are evolutionarily conserved, single stranded molecules of about 22 nucleotides in length and function post-transcriptionally by partial binding (partial complementarity) to the mRNA of genes. Binding of a specific miRNA to its target on an mRNA can inhibit its expression by a variety of mechanisms. Although the most common mechanism is translational repression as a result of miRNA binding to the 3?UTR of an mRNA, mechanisms involving mRNA degradation and destabilization have also been described. Micro RNAs are currently considered as ?master regulators? of gene expression. Since a single miRNA can bind and consequently regulate the expression of more than 100 different transcripts it has been estimated that miRNAs may be able to regulate up to 30% of the protein-coding genes in the human genome. As a result, miRNAs receive widespread attention on their potential role in complicated biological processes and multifactorial diseases. In this review we are discussing the biogenesis of miRNAs, their mode of action as well as their role in human diseases through genetic variations on their target sites.

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The introduction of medical humanities in the undergraduate curriculum of Greek medical schools: challenge and necessity

Hippokratia 2010; 14 (4):241-243

A. Batistatou, E A. Doulis, D. Tiniakos, A. Anogiannaki, K. Charalabopoulos

Abstract

Background and Aim: Medical humanities is a multidisciplinary field, consisting of humanities (theory of literature and arts, philosophy, ethics, history and theology), social sciences (anthropology, psychology and sociology) and arts (literature, theater, cinema, music and visual arts), integrated in the undergraduate curriculum of Medical schools. The aim of the present study is to discuss medical humanities and support the necessity of introduction of a medical humanities course in the curriculum of Greek medical schools. Materials, Methods and Results: Through the relevant Pub-Med search as well as taking into account various curricula of medical schools, it is evident that medical education today is characterized by acquisition of knowledge and skills and development of medical values and attitudes. Clinical observation with the recognition of key data and patterns in the collected information, is crucial in the final medical decision, i.e. in the complex process, through which doctors accumulate data, reach conclusions and decide on therapy. All sciences included in medical humanities are important for the high quality education of future doctors. The practice of Medicine is in large an image related science. The history of anatomy and art are closely related, already from the Renaissance time. Studies have shown that attendance of courses on art critics improves the observational skills of medical students. Literature is the source of information about the nature and source of human emotions and behavior and of narratives of illness, and increases imagination. Philosophy aids in the development of analytical and synthetical thinking. Teaching of history of medicine develops humility and aids in avoiding the repetition of mistakes of the past, and quite often raises research and therapeutic skepticism. The comprehension of medical ethics and professional deontology guides the patient-doctor relationship, as well as the relations between physicians and their colleagues. The Medical Humanities course, which is already integrated in the undergraduate curriculum of many medical schools of Europe, USA and Australia, includes lectures by experts and students? presentations on the above-mentioned areas and could be offered, for a semester, during the first years.Conclusion: The aim of Medical Humanities course is the development of imagination and interpretation of data through analytical complex procedures, the development of skills of close observation and careful interpretation of the patient ?language? and the enhancement of empathy for the patients, as well as the development of the physician patient relationship and finally the conceptualization/construction of personal and professional values.

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Physiology of bone turnover and its application in contemporary maxillofacial surgery.

Hippokratia 2010; 14(4):244-248

Ch. Iliopoulos, L. Zouloumis, M. Lazaridou

Abstract

Backround: Bone formation and remodelling appear as normal developmental or healing processes being inducted by several factors as BMPs, biophysical forces and IGF. A local environment consisted of those factors is created and it is responsible for the changes in the direction bone formation-bone resorption. This exact dynamic property of the bone is evaluated and utilized in the reconstructive surgical treatment of craniofacial deformities.
Methods: Data with regard to the physiology of the biological process of bone turn over are initially analysed, followed by the applications of these mechanisms in orthognathic surgery, cleft lip and palate surgery and reconstructive surgery of midfacial deformities, including experimental data after a review of the contemporary international bibliography.
Results-Conclusion: The growing knowledge of bone physiology will influence future surgery techniques and that is going to lead to greater therapeutic capabilities for our patients.

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Brain visual impairment in childhood: mini review

Hippokratia 2010; 14 (4): 249-251

N. Kozeis

Abstract

Cerebral visual impairment (CVI) is one of the leading causes of severe visual impairment in childhood. This article was written to highlight any new knowledge related to cerebral visual impairment in childhood. The international literature was searched to describe the type of visual, oculomotor and / or visuo-perceptual disturbances and to discuss the prognosis. CVI children show a wide range of visual disturbances. These could be either visual, oculomotor, perceptual or a combination of all. The severity of CVI depends on the time, location and extend of the brain damage. The visual function seems to improve in CVI children, especially in the cortically damaged, mainly due to brain plasticity. The increased survival rate of very premature infants during the last decades has increased the incidence of CVI in childhood. Better understanding of the pathophysiological mechanisms of CVI, early diagnosis and early intervention could lead to a better quality of life of these children.

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Risk factors associated with anemia among Serbian school-age children 7-14 years old: results of the first national health survey

Hippokratia 2010; 14 (4): 252-260

D. Djokic, MB. Drakulovic, Z. Radojicic, L. Crncevic Radovic, L. Rakic, S. Kocic, G. Davidovic

Abstract

Background: Anemia in school-age children is an important public health problem and available data of its prevalence and existing risk factors are essential for planning preventive strategies. The purpose of the current study was to assess the prevalence of and the risk factors associated with anemia among the school-age children 7-14 years years old in Serbia.
Methods: In the 2000 National Health Survey, a cross sectional, multistage cluster survey, performed in 1688 private and refugee campuses? households across the territory of Serbia a total of 525 cases were recruited. Socioeconomic, nutritional, physical activities and lifestyle data have been collected and hemoglobin levels were determined.
Results: The overall prevalence of anemia was 18% (94/525) [95% CI 15-21]. Age of 12-14 yrs (odds ratio 3.56 [95% CI 2.17-5.85], p=0.000), male gender (3.22 [1.92-5.42], p=0.000), refugee campuses? residence (1.98 [1.22-3.23], p=0.000), lunch skipping (3.43 [1.40-8.33], p=0.007), defective poultry intake (1.65 [1.01-2.62], p=0.047), lack of fish consumption (1.84 [1.07-3.18], p=0.028), disagreement that sport contributes protecting health (3.80 [2.02-6.95], p=0.000), absence of learning (1.80 [1.12-2.90], p=0.016) and defective book reading in free time (2.18 [1.03-4.61], p=0.04), were independent risk factors of anemia. The frequency of anemia was highest in schoolaged of male gender adolescent males 12-14 years old (46/105, 44%); in 12-14 years aged participants living in refugee campuses? households (22/63, 35%); in refugees of 7-14 yrs old male gender (32/101, 32%); in subjects with defective fish and poultry intake (35/118, 30%) and in participants who escaped reading and learning as lifestyle practices in free time (53/204, 26%).
Conclusions: Socioeconomic, nutritional, physical and lifestyle risk factors could be considered by introducing preventive strategies of anemia in school-age children in Serbia.

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Poor endoscopic findings in children with non variceal upper gastrointestinal bleeding: is biopsy necessary?

Hippokratia 2010; 14(4):261-264

A. Giannakopoulos, A. Logothetis, J. Panayiotou, K. Van-Vliet, I. Orfanou, E. Roma-Giannikou

Abstract

Background: Gastrointestinal bleeding in infants and children is a potentially serious condition in the practice of general pediatrics that requires investigation. The objective of this study is to describe the endoscopic and histopathological findings in children with upper gastrointestinal (UGI) bleeding of non variceal origin. Patients and Methods: We performed a retrospective study of the medical records of 181 children, aged 1 month to 15.2 years, with non variceal UGI bleeding, who were admitted in our department over the period 1988-2008 and underwent upper GI endoscopy accompanied by histology. Patients were divided in 4 groups according to their age (Á=0-1 years, Â= 1-6 years, C=6-12 years, D= 12-16 years).
Results: An endoscopically evident bleeding source was detected in only 5% of all patients. Histological examination revealed increased incidence of eosinophilic infiltration in infants, in contrast to all other age groups, where non-specific or H. pylori related inflammation predominated. Peptic ulcer was found in 4.4% of all patients.
Conclusion: Although an evident bleeding source was detected in only a small percentage of patients, the accompanying histological examination provided additional information regarding possible underlying diseases and contributed to the subsequent therapeutic management.

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Percutaneous Kirschner Wire fixation in distal radius metaphyseal fractures in children: does it change the overall outcome?

Hippokratia 2010; 14 (4): 265-270

M. Ozcan, S. Memisoglu, C. Copuroglu, K. Saridogan

Abstract

Background and Objectives: The aim of this study was to determine the effect of Kirschner wire fixation after closed reduction of radial metaphyseal fractures with high risk of redisplacement.
Patients and Methods: In this retrospective study 40 cases were studied in two groups. In group 1 (n=20, average age 11.2 years), K-wire fixation was performed after closed reduction. In group 2 (n=20 average age 10.1 years), only plaster immobilization was applied following closed reduction. The compared clinical and radiological parameters were, pain, limb deformitiy, range of motion of the wrist, angulation of the fracture site, radial distal epipihyseal angle and severity of translation.
Results:Redisplacement rate was 10% in group 1 and 50% in group 2. This shows, Kirschner wire fixation has a positive effect in the maintanence of the initial reduction (p0.05). Concerning the severity of translation, the risk of redisplacement increases in stage 3 (50%-100%) and stage 4 (>100%) fractures (p<0,05). Concomitant complete ulnar fracture has also redisplacement risk (p<0.05). Redisplacement risk increases when the distance of fracture line to epiphyseal line was between 11-20 mm (p<0.05). There was no significiant difference between two groups after last evaluation based on radiological parameters and clinical results (p>0.05).
Conclusions:This study shows that Kirschner wire fixation prevents redisplacement in early follow-up of first three weeks but there is no superiority after 20 months follow-up in distal metaphyseal fractures of children.

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Diagnostic yield and clinical management after capsule endoscopy in daily clinical practice: A single-center experience

Hippokratia 2010; 14 (4): 271-276

P. Katsinelos, K. Fasoylas, Gr. Chatzimavroudis, G. Lazaraki, C. Zavos, I. Pilpilidis, S. Terzoudis, G. Kokonis, I. Patsis, A. Beltsis, G. Paroutoglou, J. Kountouras

Abstract

Background: Capsule endoscopy is an effective method of examining the small bowel in patients with obscure gastrointestinal bleeding, suspected inflammatory mucosal diseases and neoplasms. We herein evaluate the diagnostic yield of capsule endoscopy and its effect on clinical management in daily clinical practice. Patients and Methods: One hundred and one capsule endoscopies performed at the Department of Endoscopy and Motility Unit of G. Gennimatas General Hospital of Thessaloniki from May 2007 to February 2009 were retrospectively reviewed. Clinical management following capsule endoscopy findings was evaluated. The most frequent indication was obscure gastrointestinal bleeding (n=56, overt=20).
Results: The overall diagnostic yield was 47.5%. The diagnostic yield was 88.9% in patients with overt bleeding who underwent early capsule endoscopy (within 5 days), versus 36.4% in patients who underwent late capsule endoscopy (p=0.028). Moreover, it reached 81.8% in patients with abdominal pain, with/without diarrhea and abnormal biological markers, versus 8.3% in patients with normal biological markers (p<0.0001). Capsule endoscopy was diagnostic in all patients with symptomatic celiac disease. Adenomas were found in 9 of 14 familial adenomatous polyposis patients. Capsule retention (>72 hours) occurred in two patients. Forty-three of 48 (89.6%) patients with positive capsule endoscopy findings that received intervention or medical treatment had positive clinical outcomes.
Conclusions: Capsule endoscopy has an important diagnostic role and contribution in the clinical management during routine clinical practice; however, it remains to be determined which patients are more likely to benefit from this expensive examination.

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Exercise-induced rhabdomyolysis from stationary biking: a case report

Hippokratia 2010; 14(4):279-280

I. Inklebarger, N. Galanis, J. Kirkos, G. Kapetanos

Abstract

There are several reports concerning exercise and rabdomyolysis. There has been no report in the English literature of exercise induced rabdomyolisis from a stationary bike. A 63-year-old female recreational athlete presented to our hospital seeking treatment for lower back, leg pain and stiffness after exercising on a stationary bicycle one day prior. Blood work showed a raised CK of 38,120 U/L, a myoglobin of 5330 and an AST 495 U/L with normal urea and electrolytes. Urinalysis remained negative. She was admitted for oral and intravenous hydration and fluid balance monitoring.This is a very rare case of rhabdomyolysis due to exercise. This study highlights the difficulties faced by accident and emergency teams in distinguishing delayed onset muscle soreness (DOMS) from exercise-induced rhabdomyolysis, and reinforces the concept that rhabdomyolysis can occur at any level of exercise intensity.

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Acute renal dysfunction in a patient presenting with rhabdomyolysis due to Hypothyroidism attributed to Hashimoto's Disease

Hippokratia 2010; 14 (4): 281-283

C. Nikolaidou, E. Gouridou, G. Ilonidis, G. Boudouris

Abstract

We describe a patient with rhabdomyolysis and acute renal dysfunction due to hypothyroidism, attributed to Hashimoto's disease. Though rhabdomyolysis could be life-threatening, it is a rare complication of hypothyroidism, especially when other precipitating factors, such as exercise, alcohol, medications or renal failure, are absent. Nevertheless, hypothyroidism can be an authentic cause of rhabdomyolysis and should always be considered when elevated creatine kinase (CK) and other muscle enzymes concentrations cannot be attributed to any major factor.

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Pyeloureteritis cystica

Hippokratia 2010; 14(4):284-285

G. Salpigidis, D. Zinolidis, S. Charalambous, A. Papathanasiou, V. Rombis

Abstract

Pyeloureteritis cystica is a rare situation of the renal pelvis and ureters, characterized by cystical formations of the epithelium. The etiology is unknown and there is no specific treatment. It is usually diagnosed accidently during imaging of the upper urinary tract for different reasons. We present a case of pyeloureteritis cystica.

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Primary atypical teratoid/rhabdoid tumor of the spine in an infant

Hippokratia 2010; 14(4):286-288

S. Stabouli, M. Sdougka, P. Tsitspoulos, A. Violaki, I. Anagnostopoulos, Ch. Tsonidis, D. Koliouskas

Abstract

Atypical teratoid/rhabdoid tumor of the spine is a rare pediatric neoplasm with poor prognosis. We report a case of an atypical teratoid/rhabdoid tumor of the cervical spine in a 2-months-old infant. The patient presented with rapidly progressing tetraparesis and respiratory failure. Magnetic resonance imaging of the spinal cord revealed an intradural, extramedullary mass occupying the spinal canal on the right at the level of C1-C5. Tumor cells were immunohistochemically positive for epithelial membrane antigen, vimentin, cytokeratins, S-100 protein, and CD57/Leu-7 antigen. Despite chemotherapy, the infant presented with progressive neurological deterioration and died 6 months after initial diagnosis. We review the literature on spinal malignant rhabdoid tumor and discuss the pathology, treatment, and outcome of these rare neoplasms.

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Successful treatment of a spontaneous haemothorax with recombinant factor VIIa in a haemophilic child with inhibitors

Hippokratia 2010; 14 (4): 289-290

D. Gidaris, M. Economou, R. Valeri, N. Gombakis, M. Athanasiou - Metaxa

Abstract

Haemophilia A is an X-linked disorder caused by a deficiency of factor VIII. Haemorrhage in various sites may occur spontaneously or secondary to trauma depending on the severity of the deficiency. Common manifestations include haemarthrosis, epistaxis, gastrointestinal haemorrhage and haematuria. Spontaneous haemothorax has rarely been reported both in children and adults1,2. We report the case of a haemophiliac child presenting with spontaneous haemothorax due to the rarity of this clinical presentation in order to raise the awareness among clinicians.

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Synchronous oesophagectomy and hepatic resection for metastatic oesophageal cancer: report of a case

Hippokratia 2010; 14(4):291-293

S S. Mudan, A. Giakoustidis, D. Giakoustidis, M. Slevin

Abstract

Background: Oesophageal cancer with liver metastasis is rare and when diagnosed is usually advanced and surgical management is contraindicated.
Method-Results: We report the case of a patient who presented with oesophageal cancer and liver metastasis. The patient received chemotherapy combined with RFA to liver tumour. Subsequently she was subjected to oesophagectomy and liver resection of segment 5 extended into segment 8. Patient underwent adjuvant chemotherapy post-operatively and remains disease-free until now, 29 months after operation.
Conclusion: Oesophageal cancer with concomitant liver metastasis is a rare and lethal disease. Multimodal management including surgery may offer prolonged survival in highly selected patients.

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Management and visualization of a kinked epidural catheter

Hippokratia 2010;14(4):294-296

T. Aslanidis, A. Fileli, P. Pyrgos

Abstract

A lumbar epidural catheter inserted in a 29-year-old woman for labor analgesia. The catheter failed to provide adequate analgesia. Moreover, after labor, it proved difficult to be removed. After computer tomography (CT) and magnetic resonance impedance (MRI) examination the course of the catheter was visible, the entrapped catheter was dislodged intact, revealing a kinking near its distal tip. Kinking of an epidural catheter leading to entrapment is an unusual complication of epidural catheterization.

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Tuberculous orchitis US and MRI findings. Correlation with histopathological findings

Hippokratia 2010; 14(4):297-299

M. Michaelides, C. Sotiriadis, D. Konstantinou, S. Pervana, I. Tsitouridis

Abstract

Tuberculosis of the testis is a rare disease. Although Ultrasound (US) findings of tuberculous epididymo-orchitis have been well described, there are only few reported cases describing the Magnetic Resonance Imaging (MR) findings of this disease. Herein, we describe the US and MR findings in a patient with tuberculous orchitis of the left testis and correlate them with the histopathological findings. In our case, the MR findings differ from previous studies because granulomatous areas in the testis had intermediate to high signal intensity on T2WI, while in all studies granulomatous areas in tuberculous epididymo-orchitis demonstrated invariably low signal intensity.

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Paraganglioma in a young patient with asymptomatic severe hypertension: a case report and review of the literature

Hippokratia 2010; 14 (4): 300-302

Ch. Koumaras, P. Anagnostis, M. Tzimou, I. Giavanidis, Th. Gossios, A. Antoniadis, Vg. Athyros, A. Karagiannis

Abstract

We present a case of a 19-year old woman who was admitted to our department with a recently, and incidentally, diagnosed severe hypertension [220/140 mmHg systolic/diastolic blood pressure (BP)]. The patient was asymptomatic. The laboratory investigation demonstrated both elevated plasma norepinephrine (1807 pg/ml, normal range 120-350 pg/ml) and 24h urinary free catecholamines (483 ìg/24h, normal range <150 ìg/24h), making the diagnosis of a catecholamineproducing tumor highly probable. Although magnetic resonance imaging of the abdomen showed normal adrenal glands, it revealed a mass (4x4 cm) anterior to the inferior vena cava. The diagnosis of paraganglioma was confirmed by the 131Imeta- iodobenzylguanidine scintigraphy. Preoperatively, á- and â-adrenergic receptor blockers were administered. After successful resection of the tumor, the patient?s BP was restored to normal and remained stable during the 3-month follow up. Plasma and 24h urinary catecholamine levels were also normalized. In conclusion, it is important to consider paragangliomas as a possible cause of secondary hypertension and proceed to diagnosis and treatment as described above, since surgical removal of the tumor, especially in sporadic cases, may cure the patient.

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