A new paradigm in the treatment of the cardiovascular disease continuum: focus on prevention

Hippokratia 2011; 15(1):7-11

SG. Chrysant

Abstract

The cardiovascular disease continuum (CVDC) is a sequence of cardiovascular events, which begins from a cluster of cardiovascular risk factors consisting of diabetes mellitus, dyslipidemia, hypertension, smoking and visceral obesity. If these factors are not intervened with early, they will, inexorably, progress to atherosclerosis, coronary artery disease, myocardial infarction, left ventricular hypertrophy, left ventricular dilatation leading to left ventricular diastolic or systolic dysfunction and eventually end stage heart failure and death. For this concise review, a Medline search of the English language literature between the years 2000 and 2009 was conducted and 33 pertinent publications were selected. Based on the evidence contained in these publications, it is possible that early intervention and treatment of the various cardiovascular risk factors, which initiate and perpetuate the CVDC, could prevent it or arrest its further progress. Therefore, this concise review will emphasize the early detection and treatment of the various cardiovascular risk factors, which initiate and perpetuate the CVDC.

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Factors influencing bone loss in paraplegia

Hippokratia 2011; 15 (1): 54-59

Y. Dionyssiotis, GP. Lyritis, AF. Mavrogenis, PJ. Papagelopoulos

Abstract

Background and aim: Significant bone loss develops in the first months and continues years after spinal cord injury. A cross - sectional comparative study was performed to evaluate factors influencing bone loss in spinal cord injured men with paraplegia.
Patients and Methods: We studied 31 paraplegic men in chronic stage (>1.5 years) in comparison with 30 able-bodied men of similar age, height, and weight. The paraplegic men were allocated into 2 subgroups based on the neurological level of injury; high paraplegics (n=16, T4-T7 neurological level of injury) and low paraplegics (n=15, T8-T12 neurological level of injury). The influence of positive and negative factors (spasticity, standing-therapeutic walking, and duration of paralysis) on bone structures was evaluated by pQCT measurement of the total, trabecular and cortical bone mineral density (BMDtot, BMDtrab, BMDcort, respectively) and cortical thickness (THIcort) at the distal tibial epiphysis and the tibial diaphysis at 4% and 38% proximal to the distal end of the tibia. The stress strain index (SSI) was measured at 14% (SSI2) and at 38% (SSI3) of the tibial diaphysis, and the difference SSI3 - SSI2 (dSSI3-2) was calculated.
Results: In all paraplegics, bone mineral density parameters were significantly reduced compared to the control group (BMDtot: p<0.0005, BMDtrab: p<0.0005, BMDcort:p=0.029, THIcort: p=0.019, SSI2: p=0.009, SSI3: p=0.003, respectively). Paraplegics who used standing frames or long brace orthoses had statistically significant higher bone mass and geometric parameters (BMDtrab: p=0.03, BMDtot: p=0.01, THIcort: p=0.013, respectively), while spasticity did not protect bone. The duration of paralysis was significantly related to trabecular bone loss (r=-0.5, p=0.05) and cortical thickness (r=-0.6, p=0.006) in high paraplegics and to SSI3-2 in low paraplegics (r=0.534, p=0.03).
Conclusions: The neurological level of injury adversely affects bone strength in paralyzed lower extremities such as the distal tibia. Standing or therapeutic walking could possibly have a positive effect in cortical and trabecular bone in paraplegia.

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Infections in hemodialysis: a concise review - Part 1: bacteremia and respiratory infections

Hippokratia 2011; 15 (1): 12-17

T. Eleftheriadis, V. Liakopoulos, K. Leivaditis, G. Antoniadi, I. Stefanidis

Abstract

Hemodialysis (HD) patients are particularly predisposed to infections. It seems that the HD procedure per se as well as disturbances in both innate and adaptive immunity significantly contribute to this susceptibility. Infections are the major cause of morbidity and the second cause of death following cardiovascular events in HD patients. Episodes of bacteremia and pneumonia account for the majority of severe infections in this population. In addition to these bacterial infections another common problem in HD units is the blood transmitted viral infections, particularly infections caused by hepatitis B virus, hepatitis C virus and Human immunodeficiency virus. A number of safety concerns exist for limiting the spread of these viral infections among HD patients and the staff of the unit. The aim of the present review is to present in a concise albeit practical form the difficult aspect of infections in HD. For practical reasons the review is separated in two parts. The present first part covers bacteremia and respiratory infections, while the second part will cover blood transmitted viral infections.

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Adipogenesis and osteoblastogenesis: trans-differentiation in the pathophysiology of bone disorders

Hippokratia 2011; 15(1):18-21

Ch. Savopoulos, Ch. Dokos, G. Kaiafa, A. Hatzitolios

Abstract

Mesechymal stem cells as pluripotent cells are involved in the differentiation of adipocytes under regulation of genes and transcription factors. The plasticity observed between adipocytes and osteoblasts differentiation is the basis of transdifferentiation, observed in both experimental and clinical level. This review analyzes not only the adipose tissue as an endocrine organ but also the underlying mechanism of trans-differentiation between adipocytes and osteoblasts. Fat and bone tissue interaction is altered by activation or silencing of genes, signaling molecules and transcription factors. Disorders of this interaction include ectopic ossification syndromes and other bone disorders like osteoporosis and multiple myeloma. Further research will reveal the instinct mechanisms of this imbalance in the pathophysiology of many metabolic disorders such as diabetes mellitus, atherogenesis e.t.c.

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Oscillating LDL accumulation in normal human aortic arch - shear dependent endothelium

Hippokratia 2011; 15(1):22-25

JV. Soulis, K. Fytanidis, VC. Papaioannou, H. Styliadis, GD. Giannoglou

Abstract

Objective: Abnormal mass transfer of blood components to the arterial walls initiates atherosclerosis. Understating the role of mass transfer within the arterial walls requires quantitative analysis. The oscillating lipid accumulation in the aortic wall is examined in the normal human aortic arch with shear dependent endothelium properties.
Methods: A semi-permeable nature of the arterial wall computational model, applied in the normal human aortic arch under unsteady normal flow and mass conditions, is incorporated with hydraulic conductivity and permeability treated as wall shear stress dependent. The coupling of fluid dynamics and solute dynamics at the endothelium was achieved by the Kedem-Katchalsky equation. A typical aortic arch blood flow waveform at resting conditions and lasting 800 msec is applied.
Results: With constant values of water infiltration and endothelial permeability the surface vertex average normalized luminal concentration is 4.25 % higher than that at the entrance. With shear dependent values the surface vertex average normalized luminal concentration is 7.3 % higher than at the entrance. The luminal surface concentration at the arterial wall is flow-dependent with local variations due to geometric features. Concave sides of the aortic arch exhibit, relatively to the convex ones, elevated low density lipoprotein at all time steps.
Conclusions: The degree of elevation in luminal surface LDL concentration is mostly affected from the water infiltration velocity at the vessel wall. Shear dependent endothelial values must be taken into account whenever fluid and mass flow within the arterial system is incorporated.

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Significant epidemiological changes in chronic hepatitis C infection: results of the nationwide HEPNET-GREECE cohort study

Hippokratia 2011; 15 (1): 26-31

M. Raptopoulou, G. Touloumi, D. Tzourmakliotis, G. Nikolopoulou, M. Dimopoulou, G. Giannoulis, T. Vasiliadis, A. Skoutelis, O. Anagnostou, G. Hatzis, S. Manolakopoulos

Abstract

Background and Aims: Hepatitis C virus (HCV) infection is an important health problem worldwide. The aim of the study is to describe the baseline characteristics and possible epidemiological changes of the patients with chronic HCV infection included in a nationwide Greek study.
Patients and Methods: two thousand eight hundred seventeen (2817) patients, followed-up at 20 hepatology centres throughout Greece between the years 1997 and 2006 were enrolled in the study.
Results: Intravenous drug use (IDU) and history of blood transfusion prior to 1992 was reported in 30.7% and 22.6% of our patients, respectively. In 1865 (66.2%) patients with known genotypes, the distribution for genotype 1, 2, 3 and 4 was 45.1%, 7%, 34% and 13.9% respectively. Genotype 1 was more common in older people, in women (55.9% p<0.001) and patients with transfusion-related hepatitis (61.6% p<0.001). Genotype 3 was more common in younger patients, in men (43% p<0.001) and in IDUs (63.3% p<0.001). A significant reduction of transfusion-related hepatitis C incidence (p<0.001) in conjunction with the proportion of genotype 1 (p<0.001) was observed during the last three decades while an increase in IDU infected patients and genotype 3 was detected.
Conclusions: Our study showed a significant change in HCV genotype distribution and source of HCV infection during the last three decades and under that scope, urgent actions are needed in order to control the spread of HCV infection.

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Analysis of fatal motor vehicle collisions: evidence from Central Macedonia, Greece

Hippokratia 2011; 15(1):32-36

G. Ampanozi, L. Kovatsi, E. Smyrnakis, E. Zaggelidou, M. Gavana, N. Papadakis, A. Benos

Abstract

Background: The objective of this study was to assess the factors associated with the traffic mortality in the region of Central Macedonia in order to produce evidence in building up preventive policies.
Material and Methods: This study is a descriptive survey covering a three-year period (from 01-01-2006 to 31-12- 2008). The data used were supplied by the regional Road Traffic Police Service in Thessaloniki.
Results: A total of 280 fatal vehicle collisions were recorded in three years, in which 312 people died. 266 (85.26%) of the 312 people who died were men and 46 (14.74%) were women. The victims were between 1 and 91 years of age (mean ± SD, 42.00 ± 20.36 years). More fatal vehicle collisions were recorded on weekends and holidays than weekdays. Regarding the type of the vehicle, occupants of two-wheeled motor vehicles were in greater risk for dying compared to heavy duty vehicle passengers, who are considered to be protected by the vehicle. Among the 312 fatalities, alcohol was detected in 87 (28%) of the drivers who were responsible for the collision. Most of them (56/86, 64.4%) were between 15 and 44 years of age. In 6 (1.9%) cases, all of them drivers, illicit substances were detected. Vehicle collisions with younger victims were recorded during the early morning hours, whereas older people died more frequently during daytime.
Conclusions: The findings of this study are providing evidence for the design and implementation of concrete and urgently needed preventive strategies in order to control the almost completely preventable fatalities of the road crashes.

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Radionuclide imaging with human polyclonal immunoglobulin (99mTc-HIG) and bone scan in patients with rheumatoid arthritis and serum-negative polyarthritis

Hippokratia 2011; 15(1):37-42

G. Gerasimou, E. Moralidis, E. Papanastasiou, G. Liaros, T. Aggelopoulou, E. Triantafyllidou, N. Lytras, L. Settas, A. Gotzamani-Psarrakou

Abstract

Background and aim: Rheumatoid arthritis (RA) is a chronic polyarthritic syndrome in which actively inflamed joints coexist with others being in remission. Compatible bone scan (BS) reveals joints with increased activity due to degenerative alterations, whilst scanning with human polyclonal immunoglobulin (HIG) is capable to show which of the joints present active inflammation of the synovial membrane. The aim of the study is to investigate the utility of molecular imaging with HIG in patients suffering from RA. Patients and methods: Forty patients (9 males plus 31 females), suffering from painful polyarthritic syndrome, with a mean age 45.3±7 years and a duration of disease 18.3±4.2 months were enrolled in the study. Twenty-six of the patients were serum positive to RA factor, considered as suffering from RA, whilst fourteen of them were RA factor negatives and they were considered as patients with serum-negative polyarthritis. All patients were submitted to x-rays and ultrasound examination (US) in joints of interest, plus whole body BS with 99mTc-MDP and finally scan with 99mTc-HIG.
Results: A total of 1680 joints have been evaluated. In 6 of the patients-two with serum negative RA (252 joints), radionuclide imaging with HIG was within normal limits, despite the fact that in compatible bone scan degenerative alterations have been mentioned in 30 joints. In all these patients disease was evaluated as inactive ("arthrotic changes"). In the remaining 34 patients-12 with serum negative RA (1428 joints), increased accumulation of HIG, concerning serum positive patients, has been mentioned to 163 joints ("arthritic changes"), whilst in the same group, BS revealed degenerative changes to 265 joints. Concerning serum negative patients, the respective results were 64 versus 190 joints. Increased uptake of HIG has been found in 189/226 swollen and painful joints (overall sensitivity according to clinical criteria 83.3%) and in 38 joints without any clinical evidence of inflammation, with clinical active inflammation presented after follow-up to 35 of them, yielding thus specificity at the level of 92%. Matched findings between these two methods have been mentioned to 185 out of 227 joints with an abnormal scan with HIG. Abnormal x-rays and US findings have been mentioned in 67 of the joints.
Conclusions: According to the above mentioned, BS in RA reveals joints being actively inflamed or not, whilst radionuclide study with HIG is capable to distinguish actively inflamed joints, even in patients with serum negative RA, in a greater extent than anatomical imaging modalities.

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Alterations of bone mineral metabolism of children with different cell lineage types of acute lymphoblastic leukaemia under chemotherapy

Hippokratia 2011; 15 (1): 43-47

A. Tragiannidis, Ch. Dokos, V. Sidi, Th. Papageorgiou, D. Koliouskas, M. Karamouzis, Ch Papastergiou, I. Tsitouridis, G. Katzos, I. Rousso, F. Athanassiadou-Piperopoulou

Abstract

Background: Children with haematological malignancies such as acute lymphoblastic leukaemia (ALL) may have alteration of bone mineral metabolism therefore increased risk for osteopenia and osteoporosis.
Patients and Methods: The purpose of this study was to examine the alterations of bone mineral metabolism in two groups of children (n=42) according to immunophenotyping (B-cell type, T-cell type) both quantitative (bone mineral density z-scores) and qualitative (serum osteocalcin - OC and carboxyl-terminal telopeptide of human type I collagen - ICTP) during diagnosis (T=0), after the intensified chemotherapy period (T=0.5) and the consolidation period (T=1).
Results: According to our results 15 patients had osteopenia and 1 child developed osteoporosis at T=0.5 and 13 patients had osteopenia at T=1. Mean BMD z-score was significantly decreased in both groups during chemotherapy and especially statistically significant decline of T-cell type ALL group compared with B-cell type ALL patients. OC mean level remains in low levels for both groups reaching in plateau during chemotherapy and ICTP level was increased in T-cell type ALL group of patients compared with B-cell type in both periods of chemotherapy.
Conclusions: It seems that not only the combination of chemotherapeutic agents but also the cell lineage of ALL are important parameters of altering bone mineral metabolism.

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Prevalence of overweight and abdominal obesity in Greek children 6-12 years old: Results from the National Epidemiological Survey

Hippokratia 2011; 15 (1): 48-53

T. Tzotzas, E. Kapantais, K. Tziomalos, I. Ioannidis, A. Mortoglou, S. Bakatselos, M. Kaklamanou, L. Lanaras, D. Kaklamanou

Abstract

Objective: To provide estimates of overweight (OW), obesity (OB) and abdominal obesity (AO) in a sample of children throughout the whole of Greece.
Material and Methods: This epidemiological, cross-sectional survey examined 3,140 children aged 6-12 y (1,589 boys and 1,551 girls) who were selected by stratified sampling through household family members of Greek adolescents attending school. Participants reported data on height, weight and waist circumference (WC). BMI and Waist to-Height ratio (WHtR) were calculated. AO was estimated using WC and WHtR.
Results: Overall prevalence of OW including OB was 31.2% in boys and 26.5% in girls, while OB prevalence was 9.4% and 6.4% respectively. The prevalence of AO based on WC (AO-WC), was similar in girls (14.2%) and boys (12.5%) while the prevalence of AO, based on WHtR (AO-WHtR), was higher in boys than in girls (25.6% vs 20.0%, p<0.0001). With increasing age, the prevalence of OW and OB decreases in both genders, and AO-WHtR only in girls. Rates of OW were significantly more prevalent in Greeks than in immigrants.
Conclusions: Overweight and obesity in Greek children is very prevalent, particularly in boys, comparable with that reported for Mediterranean European countries. Abdominal obesity also appears high. Preventive and treatment strategies are urgently needed to combat this national epidemic.

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Clinical applications of intravascular ultrasound (IVUS): experience from an academic high volume centre of Northern Greece

Hippokratia 2011;15 (1): 60-63

A. Mantziari, A. Ziakas, G. Stavropoulos, IH. Styliadis

Abstract

Background: Intravascular ultrasound (IVUS) has become a valuable tool adjunctive to coronary angiography due to its ability to directly image atheroma and the vessel wall. We aimed to evaluate the use of IVUS during diagnostic angiography and coronary interventions in a coronary intervention academic high volume center of northern Greece. Patients and Methods: IVUS studies have been retrospectively retrieved from 2005 to 2008 from the archives of the catheterization laboratory of our department. IVUS was performed in 403 patients (294 male) of mean age 62±6 years. Indications for coronary angiography +/- intervention were acute coronary syndromes (49%), stable angina (46%) and previous coronary angioplasty evaluation (5%).
Results: Forty eight per cent of the IVUS studies were performed in left anterior descending artery (LAD), 25% in right coronary artery (RCA), 18% in left circumflex artery (LCx), and the rest (9%) in left main coronary artery (LMCA) or in coronary branches. Indications for performing an IVUS study were assessment of intermediate lesions (60%), evaluation of stent placement (36.5%), and determination of stent restenosis aetiology (3.5%). Among studies performed for assessment of intermediate lesions, 63% showed a non critical stenosis. IVUS after coronary stenting revealed a suboptimal stent placement in 77% of the cases, while in cases of stent restenosis, IVUS showed inadequate initial stent deployment in 43% of the patients.
Conclusions: The use of IVUS in our department has contributed to the optimization of intervertional treatment of coronary lesions by means of evaluating borderline lesions, stenting placement and stent restenosis.

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Contractility evaluation by 2 dimensional echocardiography and gated SPECT myocardial perfusion scintigraphy in hypertensive patients with clinical presentation of atypical chest pain

Hippokratia 2011; 15 (1): 64-68

H. Yalcin, B. Karayalcin, A. Boz, B. Talay, A. Belgi, F. Yalcin

Abstract

Background: Hypertension (HT) is a growing health problem in the population and associated with increased cardiovascular event risk and mortality. In hypertensive patients,progressive left ventricular (LV) contractility deterioration is detectable by gated single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy9. We planned this study to explore the agreement in ejection fraction (EF) determination between 2 dimensional echocardiography and gated SPECT analysis in selected group of patients with hypertension.
Patients and Methods: We studied 26 consecutive patients (mean age 56.5 ± 8.8 years; 6 men) with hypertension. Quantitative contractility analysis by both echocardiography and SPECT at rest was performed to investigate the agreement between two diagnostic tests. Results: EF at rest was greater than 55 % in all patients. All patients had a clinical presentation of atypical chest pain. Therefore, in addition to quantitative contractility analysis at rest by echocardiography and myocardial SPECT perfusion scintigraphy, we examined ischemia by stress induction and determined that 10 patients had ischemic finding (38.4 %). The mean value of EF calculated by echocardiography was 67.5 ± 5.7 %, while EF by gated SPECT was 72.8 ± 8.5 %. We documented an acceptable agreement in EF determination between these 2 diagnostic tests by meaningful correlation (r = 0.556, p = 0.003). There was no regional contractility deterioration despite existence of ischemia in 10 patients of the study group.
Conclusions: We observed that both echocardiography and gated SPECT can be used for quantification of EF in the hypertensive patients with an acceptable agreement.

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Comparison between low flow sevoflurane anesthesia and total intravenous anesthesia during intermediate-duration surgery: effects on renal and hepatic toxicity

Hippokratia 2011; 15 (1):69-74

SH. Sahin, SO. Cinar, I. Paksoy, N. Sut, S. Oba

Abstract

Background: Renal and hepatic dysfunction or injury might be involved by ether based anesthetic and intravenous anesthetic drug or surgical stress. The purpose of this study is to compare the effect of moderate duration low-flow sevoflurane versus total intravenous anesthesia on renal and hepatic functions.
Patients and Methods: Eighty (80) patients between the ages of 25-70 scheduled for elective lumbar disc herniotomy, with an expected operation time of 120-240 min, were enrolled in the study. Anesthesia was induced using remifentanil, propofol and atracurium. Patients were randomly divided into two groups. After intubation, Group S (n=40) received sevoflurane and Group T (n=40) received total intravenous anesthesia with propofol in oxygen and air with a fresh gas flow of 5 L min-1. Ten minutes after induction the fresh gas flow was decreased to 1L min-1 in both groups. Serum BUN, creatinine, ALT, AST, LDH and 24 hours excretion of glucose, protein, and creatinine in urine were measured preoperatively and the first three postoperative days.
Results: Serum BUN at 48 hours, creatinine at 24, 48. hours, and urine glucose at 24, and 48 hours were significantly higher from the preoperative values in Group S (p<0.05). However, serum BUN and creatinin, urine glucose were within the normal range. There were no significant differences in the renal and hepatic function tests between the groups.
Conclusions: These results show that the renal and hepatic effect of moderate duration low-flow sevoflurane and total intravenous anesthesia is similar.

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The role of tumor size and patient's age as prognostic factors in laryngeal cancer

Hippokratia 2011; 15(1):75-80

K. Markou, J. Goudakos, S. Triaridis, J. Konstantinidis, V. Vital, A. Nikolaou

Abstract

Background and aim: The loco-regional recurrence of laryngeal carcinoma in patients who underwent total laryngectomy is related to numerous factors. Aim of the present study was to investigate the role of patient's age and tumor size in the recurrence rate of patients. Additional aim of the current study was to investigate the possible associations between the size of the tumor and other characteristics.
Patients and methods: In 1st Department of Otorhinolaryngology of AHEPA University Hospital, from 1992 to 2007, 255 patients with laryngeal carcinoma underwent total laryngectomy. Accurate data regarding the size of the tumor were obtained. Total laryngectomy was the initial treatment in 212 patients, while in the remaining 43 patients was performed as salvage surgery after recurrence.
Results: The median tumor size was 2.74 cm (0.8-5.5 cm). There was no significant difference in the median tumor size between the patients who had recurrence (2.87 cm) and the disease free patients (2.69 cm). The median size of glottic tumors (2.47 cm) was smaller than that of supraglottic (2.95 cm) and of subglottic tumors (3.27 cm) (p<0.05). Among the 255 patients, recurrence of the tumor occurred in 73 (28.7%). Statistical analysis of the data showed that the tumor size was affecting the recurrence rate in a different manner, according the stage of the tumor. The recurrence rate in T3 neoplasms was higher in larger tumors than in smaller (13.2% for tumors4cm), while T4 carcinomas appeared to have the opposite behavior (66.5% for tumors <2cm, 23% for tumors >4cm). The median tumor size in T4 patients that recurred was smaller than in those with no recurrence (2.8 cm Vs 3.3 cm). This behavior was observed in T4 tumors from all sites. Patients who experienced recurrence and had positive neck lymph nodes at the time of the initial diagnosis appeared to have smaller laryngeal tumors (2.7 cm), compared to with the same group of patients with no recurrence (3.5 cm). Supraglottic location and advanced T stage showed a statistically significant impact on disease free survival, based on Cox regression model.
Conclusions: Smaller sized tumors in patients with locally advanced laryngeal cancer (T4) or regionally (N+) appear to have more aggressive behavior and higher recurrence rate. Thus, the small tumor size could be regarded as an unfavorable prognostic factor for those laryngeal cancer cases.

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Use of propranolol in infantile haemangiomas: report of five cases and review of the literature

Hippokratia 2011; 15 (1):81-83

D. Gidaris, M. Economou, V. Hatzidemetriou, N. Gombakis, M. Athanassiou - Metaxa

Abstract

Infantile haemangiomas are common benign tumours that do not require treatment unless they cause significant functional impairment or disfigurement. We report our experience with the off-label use of propranolol in 5 children with haemangiomas and review the relevant literature.

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Breast ductal carcinoma and metastatic lymphoma to the contralateral breast in patient with cutaneous non-Hodgkin lymphoma

Hippokratia 2011; 15 (1): 84-86

B. Di Nubila, S. Meroni, L. Bonello, F. Peccatori, E. Cassano, M. Bellomi

Abstract

Breast lymphoma is a rare condition, both as a primary and a metastatic manifestation. The primary form has an incidence ranging from 0.04% to 0.5% of all breast neoplasms, whereas the metastatic form has an incidence of 0.07%. We hereby report a clinical case of a patient who presented with cutaneous non-Hodgkin lymphoma (NHL) in the left scapulohumeral region treated with surgery followed by radiotherapy (40 Gy total). Three years following radiotherapy, the patient was diagnosed with a left breast infiltrating ductal carcinoma, treated with conservative surgery and adjuvant therapy. The following year, i.e. four years after the initial diagnosis of NHL, two lymphoproliferative relapses occurred: in the left cutaneous scapulohumeral region at the original site of disease, and in the right breast. The aim of this paper is to highlight an uncommon oncologic disorder such as breast lymphoma, highlighting its clinical and radiological manifestations. Some studies reported a possible aetiological role of radiotherapy in the development of breast cancer following treatment of NHL, and in the development of breast cancer following treatment of Hodgkin lymphoma, which could potentially explain our findings.

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Imaging of an unusually located aggressive osteoblastoma of the pelvis: a case report

Hippokratia 2011; 15 (1):87-89

M. Pilavaki, G. Petsatodis, E. Petsatodis, A. Cheva, P. Palladas

Abstract

Introduction: We present a case of an aggressive osteoblastoma involving the posterior acetabular column and the ischium, which is very rare location for the tumor.Case presentation: A 21-year-old man presented with a persistent pain on the left buttock which extended on the rear surface of the thigh and the front surface of the left hip. A plain radiograph, a CT and MRI examinations were performed. The tumor was radically excised and histologically it proved to be an aggressive osteoblastoma.
Conclusions: Although aggressive osteoblastoma is a rare entity it should be considered in the differential diagnosis of bone tumors. Our purpose is to reveal the radiographic presentation of this rare tumor.

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Atypical hemolytic-uremic syndrome (HUS) with recovery after a long-lasting anuria: a case report

Hippokratia 2011; 15 (1): 90-92

H. Georgaki-Angelaki, N. Stergiou, A. Kapogiannis, I. Orfanou, B. Grapsa, E. Roma

Abstract

We report a case of a seven-year-old girl who suffered from atypical Hemolytic Uremic Syndrome (aHUS) complicated by septicaemia, central nervous system involvement, and cholangiitis. She remained anuric requiring treatment with peritoneal dialysis (PD) for a five-month period. In addition to conventional therapeutic measures including fresh frozen plasma (FFP) and blood cells transfusions she also underwent to plasma exchange (PE) treatment. Following a stormy hospitalization period of 17 weeks, the patient finally regained renal function and three years later she remains well on antihypertensive treatment and free of dialysis.

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Bolus fluorouracil induced syncope and pulseless ventricular tachycardia: a case report

Hippokratia 2011; 15 (1): 93-95

E. Fidan, S. Fidan, B. Yildiz, I. Durmus, H. Kavgaci, F. Ozdemir, F. Aydin

Abstract

5-fluorouracil is an anti-cancer drug commonly used in oncology practice. Typical side effects are myelosupression, nausea,vomiting, diarrhea and stomatitis. Cardiotoxicity is the other toxicity. Cardiac side effects are ST segment changes,rhythm abnormalities, supraventricular and ventricular dysrhytmias. Pulseless ventricular tachycardia and ventricular fibrillation releated with bolus fluorouracil were not detected in the literature. Here we discussed a 46 year-old male patient that has no known cardiac history. After bolus fluorouracil administration, syncope and pulseless ventricular tachycardia developed in this patient. There are a few explanations about the cardiotoxicity of fluorouracil. One of these is the effect on nitric oxide. It causes a reduction in the levels of endothelial NO and this leads coronary vasospasm. Another explanation is protein kinase C mediated vasospasm. In animal studies toxic myocarditis like lesions were detected with fluorouracil infusions. Finally both myocardit and vasospasm may lead cardiac problems like sudden cardiac deaths. Bolus 5-fluorouracil is as cardiotoxic as 5-fluorouracil infusion and we must be careful about the arrhytmia after the bolus administration.

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