Reading performance and central field loss

Hippokratia 2011; 15 (2): 103-108

E. Kanonidou

Abstract

Age-related macular degeneration is a major cause of blindness in Europe and the U.S. and a leading cause of significant loss of visual acuity in elderly patients. Reading is a key visual task in everyday living involving a synthesis of a number of different motor, sensory and cognitive functions. When the centre of a reader???s visual field is obscured, reading speed declines and oculomotor pattern differs, compared to normal reading. Improvement in the generation of visual stimuli using computer-generated images and projection/display systems as well as advances in eye movement recording techniques, including infrared pupil tracking and magnetic search coils, have contributed greatly to our understanding of these sensorimotor abnormalities. The developed reading strategies have been thoroughly investigated in individuals with central field loss either induced artificially or related to eye pathology.The following review aims at presenting the contemporary literature regarding the sensory and oculomotor deficits in reading ability, resulting from central field loss and should contribute to a greater understanding of the functional visual deficit caused by this visual impairment.

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Digital coverage with flaps from the same or neighboring digits

Hippokratia 2011; 15(2):153-156

L K. Papatheodorou, Z H Dailiana, S E. Varitimidis, M E Hantes, G K. Basdekis, K N Malizos

Abstract

Objective: Several flaps can be dissected from the same or neighboring digits for the reconstruction of relatively large
soft tissue digital defects.
Material and Methods: In a 6-year period, 106 large soft tissue digital defects were reconstructed with the use of flaps in 101 patients. For the reconstruction of 75 fingertip defects 73 neurovascular, island or advancement flaps (42 homodigital, 18 heterodigital, 13 advancement) and 2 thenar flaps were used. The 31 defects of the proximal and middle phalanges were reconstructed with 3 intermetacarpal and 28 cross-finger flaps (17 de-epithelialized and 11 classic for dorsal and palmar defects respectively).
Results: All flaps survived. Subjectively, the results were rated as good or excellent in 69 of 73 distal defects reconstructed with neurovascular island or advancement flaps and in 29 of 31 proximal defects treated with cross-finger and intermetacarpal flaps. The mean DASH score was 4.1 and 3.34 for the neurovascular island/advancement flaps and the cross-finger flaps respectively.
Conclusions: This study elucidates the indications and presents the advantages and disadvantages of flaps used for reconstruction of proximal and distal digital defects. Good results can be obtained with appropriate flap selection and meticulous surgical technique.

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Clinical use of erythropoietin in chronic kidney disease: outcomes and future prospects

Hippokratia 2011; 15(2):109-115

ST. Provatopoulou, PN. Ziroyiannis

Abstract

The introduction of erythropoietin (Epo) in clinical practice, more than two decades ago, altered completely the management
of patients with chronic kidney disease (CKD). The successful correction of anemia of CKD has resulted in reduction of associated morbidity and improvement of functionality, exercise tolerance, cognitive function and overall quality of life.Moreover, significant reduction of cardiovascular morbidity and mortality has occurred. Recently, large randomized clinical studies suggested that administration of Epo targeting at complete anemia correction is accompanied by significant increase of morbidity and mortality, compared to partial anemia correction. This observation has led to thorough investigation of the mechanisms of Epo actions and the possible contribution of other parameters including iron availability, comorbidities and resistance or hyporesponsiveness to Epo. In this context, it has been proposed that high doses of Epo are likely to exert toxic effects and pleiotropic systemic actions. Recognition of the extra-hematopoietic biologic actions of erythropoietin is a result of the better understanding of its interaction with Epo receptors in several tissues and organ systems, during fetal development as well as in the adult organism. More specifically, antiapoptotic, anti- inflammatory, angiogenetic and cytoprotective effects have been revealed in the kidneys, cardiovascular system, brain and retina. Until future studies are able to clarify the multiple beneficial or unfavorable effects of Epo, it is advisable to remain prudent in its administration, yet optimistic about its possible contribution in a number of pathologic conditions.

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Rare potential complications of thyroid fine needle biopsy

Hippokratia 2011; 15 (2): 116-119

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

Abstract

Thyroid fine needle biopsy (FNB) is the procedure of choice for the management of thyroid nodules. Serious complications after FNB are rare, but there is also an underestimation of complication risk because of record, selection and publication biases. Hypothesis: Apart from the well-documented post-FNB complications, we hypothesized that there are potential complications following FNB, albeit supported by limited evidence in the literature. According to our hypothesis,there may be five distinct expected rare complications: 1) cyst fluid leakage; 2) anaphylactic reaction; 3) pneumothorax; 4) thromboembolism and 5) needle tract seeding of medullary thyroid carcinoma (MTC) or thyroid lymphoma.
Conclusions: Cyst fluid leakage and pneumothorax may be of minimal clinical significance. Needle tract seeding of MTC or thyroid lymphoma may not have significant clinical consequences, if someone considers the easiness and effectiveness of surgical removal of needle tract seeding in cases of differentiated thyroid carcinoma. On the contrary, anaphylactic reaction or thromboembolism may be life-threatening. The performers of thyroid FNB are hereby encouraged to publish these complications, if they ever occur, because awareness of them could render FNB even safer.

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Infections in hemodialysis: a concise review. Part II: blood transmitted viral infections.

Hippokratia 2011; 15 (2): 120-126

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 previous first part covered bacteremia and respiratory infections, while the present second part covers blood transmitted viral infections.

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The factors contributing to the risk of sudden infant death syndrome

Hippokratia 2011; 15(2):127-131

E. Athanasakis, S. Karavasiliadou, I. Styliadis

Abstract

Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene and review of the clinical history. SIDS is one of the leading causes of infant mortality and occurs from the first month, until the first year of life for newborns and infants.The aim of this review was to identify and examine risk factors responsible for causing the sudden infant death and to propose certain measures in order to protect newborns and infants from sudden death.The potential factors that contribute to the occurrence of SIDS include inadequate prenatal care, low birth weight (<2499gr), premature infants, intrauterine growth delay, short interval between pregnancies and maternal substance use (tobacco, alcohol, opiates). Moreover, factors related to infant???s sleep environment such as the prone or side sleeping position and thick coverlet increase the risk of sudden death in infants. Also, the combination of risk factors such as that of prone sleeping position and soft bed mattress are linked to a 20-fold increased risk of death. Finally, polymorphisms in the serotonin transporter gene (5-HTT), viral respiratory infections, long Q-T (responsible for the presence of fatal arrhythmia) are related to the SIDS. Literature review indicates that each individual risk factor contributes to the appearance of SIDS and the establishment of certain protective measures for parents and health professionals has reduced its prevalence. But the precise identification of the SIDS causes and how these contribute to the occurrence of sudden death in neonates and infants, remains a challenge for health professionals.

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Sarcopenia: An emphasis on occlusion training and dietary protein

Hippokratia 2011; 15 (2): 132-137

J P. Loenneke, T J. Pujol

Abstract

Demographics reveal that the world???s population aged 60 years and older will triple from 600 million in 2000 to more 2 billion by the year 2050. To remain independent and healthy, an important factor to consider is the maintenance of skeletal muscle, as the elderly seem to become prone to a progressive loss of skeletal muscle with aging, termed sarcopenia.Interventions should focus on resistance training and optimal nutrition. Low intensity occlusion training may provide a mode of resistance training more applicable to the elderly, due to the lower loads used. Furthermore, an emphasis must be placed on high quality protein adequately distributed throughout the day to maximize protein synthesis. The use of drug therapy may be of some benefit, but it appears exercise and diet likely plays a more prominent role in the preservation of muscle mass and strength than administration of synthetic hormones.

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Anaphylactic and anaphylactoid reactions during the perioperative period

Hippokratia 2011; 15(2):138-140

V. Lagopoulos, E. Gigi

Abstract

Anaphylactic reactions in the peri-operative period are often serious and potentially life-threatening conditions, involving multiple organ systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils. Anaphylaxis is an immune mediated type I allergic reaction following the massive release of mediators from mast cells and basophils as a response to an allergen. Anaphylactoid reactions are defined as those reactions that produce the same clinical picture with anaphylaxis but are not IgE mediated, occur through a direct nonimmune-mediated release of mediators from mast cells and/or basophils or result from direct complement activation.The occurrence of these reactions during anesthesia, although quite rare, remains a major concern for the anesthesiologists.Thus, the need for systematic screening before surgery and the awareness and expert advice to anaesthesiologists seems to be very critical.

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Defining overweight and obesity among Greek children living in Thessaloniki: International versus local reference standards

Hippokratia 2011; 15 (2): 141-146

A. Christoforidis, M. Dimitriadou, E. Papadopolou, D. Stilpnopoulou, G. Katzos, M. Athanassiou-Metaxa

Abstract

Background: Body Mass Index (BMI) offers a simple and reasonable measure of obesity that, with the use of the appropriate reference, can help in the early detection of children with weight problems. Our aim was to compare the two most commonly used international BMI references and the national Greek BMI reference in identifying Greek children being overweight and obese.
Methods: A group of 1557 children (820 girls and 737 boys, mean age: 11.42 ± 3.51 years) were studied. Weight and height was measured using standard methods, and BMI was calculated. Overweight and obesity were determined using the International Obesity Task Force (IOTF) standards, the Centers for Disease Control and Prevention (CDC) BMI-forage curves and the most recent Greek BMI-for-age curves.
Results: Results showed that the IOTF's cut-off limits identifies a significantly higher prevalence of overweight (22.4%) compared with both the CDC's (11.8%, p=0.03) and the Greek's (7.4%, p=0.002) cut-off limits. However, the prevalence of obesity was generally increased when it was determined using the CDC's cut-off limits (13.9%) compared to the prevalence calculated with both the IOTF's (6.5%, p=0.05) and the Greek's (6.9%, n.s.) cut off limits.
Conclusions: The use of the national Greek reference standards for BMI underestimates the true prevalence of overweight and obesity. On the contrary, both the IOTF and the CDC standards, although independently, detect an increased number of overweight and obese children and thus they should be adopted in the clinical practice for an earlier identification and a timelier intervention.

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Mycoplasma pneumoniae respiratory tract infections among Greek children

Hippokratia 2011; 15 (2): 147-152

M. Almasri, E. Diza, A. Papa, M. Eboriadou, E. Souliou

Abstract

Background: M. pneumoniae is a common cause of respiratory tract infections (RTIs) of variable severity especially in children. New diagnostic techniques offered more reliable information about the epidemiology of infection by this pathogen.
Aim: The aim of this study was to investigate the prevalence and epidemiology of acute M. pneumoniae infections among Greek children hospitalized for RTIs using more advanced techniques.
Material and Methods: The study included 225 Greek children hospitalized for RTIs during a 15-month period. Throat swab
specimens were tested by PCR for the detection of M. pneumoniae, while IgG and IgM antibodies were determined by ELISA and, in certain cases, also by western-blot. In parallel, specimens were tested for the presence of additional respiratory pathogens.
Results: M. pneumoniae infection was diagnosed as the only pathogen in 25 (11.1%) cases, being the second (after respiratory syncytial virus- RSV) most often detected pathogen. The proportion of cases with M. pneumoniae infection in age group 8-14 years (23.3%) was significantly higher than that in <3 years age group.
Conclusion: During our study period, M. pneumoniae was the second causative agent of RTIs after RSV. The proportion of children with M. pneumoniae RTIs increased with age, while most cases were reported during summer and autumn.

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Epidemiological and clinical characteristics of human parvovirus B19 infections during 2006-2009 in Northern Greece

Hippokratia 2011; 15 (2): 157-160

M. Exindari, D. Chatzidimitriou, A. Melidou, G. Gioula, L. Ziogou, E. Diza

Abstract

Background. Parvovirus B19 infects children and adults, often causing erythema infectiosum, polyarthritis, but also aplastic crisis in patients with chronic haemolytic anaemia, rash, fever and fetal hydrops or fetal death. This study aims at the detection of acute parvovirus B19 infections during 2006-2009 in northern Greece on epidemiological and clinical aspect.
Material and methods. Specimens were obtained from 63 patients, who addressed to hospitals, suspected for acute parvovirus B19 infection (17 in 2006, 29 in 2007, 10 in 2008 and 7 in 2009). Thirty (47.6%) were children (one day - 15 years old) and 33 (52.4%) were adults (16-65 years old). The infection was shown by PCR in whole blood and/or pleural fluid and supported by detection of specific IgM antibodies in the patients??? blood serum, which was performed by ELISA.
Results. Twenty (31.7%) out of the 63 specimens were found to be positive: 3/17 (17.6 %) in 2006, 16/29 (55.2 %) in 2007, none in 2008 and 1/7 (14.3%) in 2009, p=0.0002. Positive children were found 10/30 (33.3%) and positive adults 10/33 (30.3%). Specific IgM antibodies were detected in all 20 positive patients. Children developed hematological disorders, mainly types of anemia (6 cases), hydrothorax/ascites (2 cases), arthritis (1 case), and liver transplant rejection (1 case). Adults were presented with pregnancy complications (2 cases), arthralgia/arthritis (4 cases), febrile syndromes (3 cases) and atypical rash (1 case).
Conclusions. In conclusion, an annual variation in the circulation of parvovirus B19 was noticed, presenting an increase of acute infections in northern Greece during 2007. Regarding serious cases, although children and adults seemed equally affected, differences in clinical manifestations were observed between them, with hematological dysfunctions predominant in childhood.

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The effects of glutamine on hepatic ischemia reperfusion injury in rats

 Hippokratia 2011; 15 (2): 161-166

S. Sozen, M. Kisakurek, F. Yildiz, M. Gonultas, A S. Dincel

Abstract

Aim: To evaluate the effects of glutamine on the hepatic ischemia reperfusion injury in rats.
Methods: Thirty rats were divided into three groups as sham (Group 1), control (Group 2), and glutamine(gln) treatment group (Group 3). All rats underwent hepatic ischemia for 45 min followed by 60 min period of reperfusion. Rats were intraperitoneally infused with only 0.9% saline solution in group 2. Rats in group 3 received gln (0.75 g/kg) by intraperitoneal administration, before ischemia and before reperfusion. Blood samples and liver tissues were harvested from the rats, and then the rats were sacrificed. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels were determined. Total antioxidant capacity (TAC), catalase (CAT), total oxidative status (TOS), oxidative stress index (OSI) and myeloperoxidase (MPO) in hepatic tissue were measured. Also liver tissue histopathology was evaluated by light microscopy.
Results: The levels of liver enzymes in group 3 were significantly lower than those in the group 2. TAC in liver tissue was significantly higher in group 3 than in group 2. TOS, OSI and MPO in hepatic tissue were significantly lower in group 3 than the group 2. Histological tissue damage was milder in the gln treatment group than that in the control group.
Conclusion: Our results suggest that gln treatment protects the rat liver against to hepatic ischemia-reperfusion injury.

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Allocation of renal grafts to older recipients does not result in loss of functioning graft-years

Hippokratia 2011; 15(2):167-169

D. Vrochides, M. Hassanain, P. Metrakos, J. Tchervenkov, P. Chaudhury, G. Chan, S. Paraskevas

Abstract

Background: Most deceased donor kidney allocation protocols are based on waiting time and do not take into account either recipient's life expectancy. This study investigates whether graft survival is affected by patient life expectancy.
Methods: A total of 640 adult kidney transplants were performed. Recipients were divided in group A (patients ! 50 years) and group B (patients > 50 years). The status of graft+recipient combination was characterized as: a) deceased recipient with functional graft, b) alive recipient with functional graft and c) deceased or alive recipient with nonfunctional graft.
Results: Mean kidney recipient survival was 15.15 (95% CI: 14.54, 15.77) and 12.40 (95% CI: 11.47, 13.33) years for groups A and B respectively (p < 0.0001). Mean graft survival was 13.62 (95% CI: 12.81, 14.43) and 12.42 (95% CI: 11.59, 13.25) years for groups A and B respectively (p=0.6516).Non-functional grafts were identified in 18.4% (n=57) and 16.4% (n=54) of group A and B respectively.
Conclusions: Allocation of renal grafts to older patients does not result in significant loss of graft-years. Recipients??? life expectancy has a small impact on graft survival. We should not deviate from the basic principles of equality, when kidney allocation systems are designed.

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The clinical presentation of Von Meyenburg complexes

Hippokratia 2011; 15(2):170-173

E. Sinakos, L. Papalavrentios, D. Chourmouzi, D. Dimopoulou, A. Drevelegas, E. Akriviadis

Abstract

Von Meyenburg Complexes (VMCs) is a rare clinicopathologic entity, consisting of small (<1.5cm), usually multiple and nodular cystic lesions. VMCs typically cause no symptoms or disturbances in liver function and thus in most instances they are diagnosed incidentally. We present four VMCs cases, each with a distinct clinical presentation. In two of our cases, VMCs caused mild, non-specific abdominal symptoms, including diffuse abdominal pain and discomfort. In the other two cases, in a 60-year-old woman and a 25-year-old man, the clinical presentation was implicative of an infectious hepatic process reminiscent of cholangitis and liver abscesses respectively. In each case the diagnosis was based on magnetic resonance imaging and magnetic resonance cholangiopancreatography findings showing multiple hyper-intense cystic nodules not communicating with the biliary tree. Physicians should be aware of the entire clinical spectrum of VMCs and its unique radiologic features in order to differentiate VMCs from other cystic liver lesions.

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A new variant of Todani type I choledochal cyst. Imaging evaluation

Hippokratia 2011; 15(2):174-177

M. Michaelides, V. Dimarelos, D. Kostantinou, A. Bintoudi, F. Tzikos, V. Kyriakou, G. Rodokalakis, I. Tsitouridis

Abstract

Background and aim: Choledochal cysts are congenital segmental aneurysmal dilatations of any portion of bile ducts, most commonly of the main portion of the common bile duct. The classification system of choledochal cysts is based on the site of the cyst or dilatation and currently includes 5 major types. The purpose of our study is to describe the imaging findings of a new variant of choledochal cyst.
Materials and Methods: Six patients (4 children and 2 adults, 4 females and 2 males, 3-67 year old) were evaluated by US, CT, CT-cholangiography, MRI, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP), because of jaundice, abdominal pain and a palpable mass.
Results: A new type of choledochal cyst was demonstrated in all cases. In this new variant apart from the dilatation of the common hepatic and the common bile duct, dilatation of the central portion of the cystic duct was also observed, giving a bicornal configuration to the cyst.
Conclusion: The imaging findings of a new variant of choledochal cyst with participation of the cystic duct are described. We propose the classification of this type of choledochal cyst as a new subtype of Todani I cyst, namely Todani ID.

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Combined rupture of the patellar tendon, anterior cruciate ligament and lateral meniscus. A case report and a review of the literature

Hippokratia 2011; 15(2):178-180

A. Tsarouhas, M. Iosifidis, D. Kotzamitelos, S. Traios

Abstract

Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament and the lateral meniscus in a 38-year old recreational martial arts athlete after a direct kick on his left knee. A two-stage treatment approach was performed with an excellent functional outcome.

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Ceftriaxone associated urolithiasis in a child with hypercalciuria

Hippokratia 2011; 15(2):181-183

VJ Lozanovski, Z. Gucev, VJ. Avramoski, I. Kirovski, P. Makreski, V. Tasi

Abstract

We present a 5-year-old boy with pneumonia who complained of right lumbar pain on the 7th day of treatment with Ceftriaxone.
Ultrasound examination revealed mild to moderate right hydronephrosis. Under spasmoanalgetic therapy and hydration there was spontaneous passage of three small calculi. Infrared spectroscopy showed that the calculi were composed of calcium-ceftriaxonate. Full metabolic investigation was performed and moderate hypercalciuria was detected, suggesting the role of hypercalciuria in ceftriaxone-associated nephrolithiasis.

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Transfusion-related acute lung injury management in a pediatric intensive care unit

Hippokratia 2011; 15(2):184-186

J. Dotis, S. Stabouli, A. Violaki, L. Vogiatzi, M. Mitroudi, M. Oikonomou, M. Athanassiou-Metaxa, M. Kotsiou

Abstract

Transfusion-related acute lung injury (TRALI) constitutes a life threatening complication of blood transfusion. In severe TRALI cases supportive care with mechanical ventilation in intensive care unit is needed. We present two severe TRALI cases caused by leukocyte depleted, ABO compatible, packed red blood cell transfusions, coming from multiparous women donors. In the first case diagnosis was based on clinical findings and established by the identification of leukocyte antibodies in donor's unit and recipient's serum and she deal with invasive mechanical ventilation. In the second case, diagnosis was based on clinical criteria and chest radiograph findings and non-invasive mechanical ventilation was used. Both cases were treated in a Pediatric Intensive Care Unit and they had a favorable outcome.

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