Polycystic ovary syndrome: a major metabolic disorder that may cause serious health issues

Hippokratia 1999, 3(2): 51-56

D. Panidis, A. Kourtis

Abstract

Polycystic ovary syndrome (PCOS) is characterized by defects in primary cellular control mechanisms which are responsible for chronic anovulation and hyperandrogenism. The underlying pathogenesis of the disorder is not well understood. However, abnormalities in the hypothalamo - hypophyseal axis, decreased ability of FSH to act physiologically on the granulosa cells, defects in ovarian and adrenal steroidogenesis, as well as hyperinsulinemia due to insulin-resistance, have been noted. PCOS follicles develop to the small antral stage and do not undergo the process of selection or further follicular growth, unless stimulated by exogenous gonadotropins or elevated endogenous gonadotropins. The metabolic syndrome is an integral part  polycystic ovary syndrome. In most affected women, PCOS is a metabolic disorder affecting multiple body systems that requires comprehensive and long­term evaluation and management.

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The prognostic value of evaluation of the total number of morphological anomalies in 100 spermatozoa in the semen specimens of infertile men

Hippokratia 1999, 3(2):57 - 63

D. Panidis, A. Kourtis, I. Kalahanis, K. Stergiopoulos, P. Stamatopoulos, N. Prapas, G. Vlassis

Abstract

This prospective study was designed in order to estimate the value of the measurement of the total number of morphological anomalies in 100 spermatozoa in the discrimination of semen in subfertile men. We studied semen specimens from 556 men, aged 20-58 years, who were divided into two groups, in subfertile (n=355) and in fertile men (n=201). Semen was examined in all subjects twice, (6 to 8 weeks interval). It was found that: (1) the sensitivity and specificity of the total morphological abnormality number in 100 spermatozoa, in discriminating the subfertile semen were high, (2) the total morphological abnormality number in 100 spermatozoa had higher sensitivity and specificity values than those of the spermatozoa number per ml, the percentage of the motile spermatozoa and the percentage of the spermatozoa with normal morphology, (3) the main semen parameter that presented independent correlation with the total number of morphological anomalies in 100 spermatozoa was the percentage of spermatozoa with abnormal morphology. Our results show that the total number of morphological anomalies in 100 spermatozoa is a reliable index for discriminating subfertile from fertile semen. Moreover, spermatozoa with one morphological anomaly present quite often a second morphological anomaly as well.

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Spieghelian Hernia

Hippokratia 1999, 3(2):64 - 67

A. Sakadamis, K. Ballas, K. Denga

Abstract

It is well known that Spigelian hernia presents too many diagnostic difficulties. In an effort to detect these difficulties we studied retrospectively the patients with Spigelian hernia that was treated at the second Surgical Propedeutical Department of the Hippokration Hospital of Thessaloniki.
During the period 1981-1998, nine patients with Spigelian hernia, were treated. Eight of them were women and 1 man. Patient's age ranged 41 to 69 years (54,5±10,35). Pain was the main symptom in all cases and four patients developed also a fluctuate swelling. Duration of symptoms was 1 month to 30 years (mean 6,7 years). Diagnosis was delineated preoperatively in only 6 cases. Two cases of low Spigelian hernia were falsely diagnosed as inguinal hernia and another one as lipoma. Three patients underwent CAT scan and ECHO. All patients were surgically treated.
In conclusion, Spigelian hernia presents too many difficulties in diagnosis. CAT scan and ECHO are very useful diagnostic tools. Surgical treatment gives very good results with only few recurrences.

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Anticipation of end stage renal disease in patients with autosomal dominant polycystic kidney disease

Hippokratia 1999, 3(2):68 -72

N. Sotirakopoulos, T. Tsitsios, Ch. Cristodoulidou, S. Spaia, K. Mavromatidis

Abstract

Polycystic kidney disease is an autosomal dominant hereditary disease, which is inherited by the 50% of offspring, irrelevant of sex and it has a various phenotypic expression. From the beginning it was noted that the expression was similar intrafamilial, but nowadays in some studies the results were different. The aim of this study was to evaluate the timing of renal death between ancestor and offspring (in successive generations).
We have studied 47 pairs of patients with adult autosomal dominant polycystic kidney disease (ADPKD). Echo findings were used as criteria for the diagnosis. Date of dialysis initiation, ancestor and ollspring sex of parents with APDK were necessary for the inclusion in the study. We did not included more than one pair from each family.We found that the end stage renal disease in ADPKD appears in the same age between ancestors and offsprings (49.4±8.2 y vs. 52.5±11.6 y, p=NS) independently of offspring sex. Patients who inherited the disease form parents came to end stage renal failure earlier than the ancestors (48.2±8.5 y vs. 53.0±9.9 y, p<0.05), but not those who inherited the gene from the mother (51.7±7.3 y Vs 51.7±9.6 y, p=NS).In conclusion in ADPKD pts between successive generations the renal death comes : a) In offsprings as in the ancestors, b) the sex of the offspring does not has any relation to the renal death and c) renal death comes earlier in offsprings than the ancestors in patients who inherited the disease form father but not from mother.

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Correlation between serum leptin levels and age, duration of postmenopausal period and body mass index

Hippokratia 1999, 3(2): 73-76

D. Panidis, A. Kourtis, K. Stergiopoulos, E. Spanos, G. Vlassis

Abstract

The aim of the present study was to estimate serum leptin levels in menopausal women and to detect the correlation between the levels of this hormone and the age of these women, the duration of the postmenopausal period, and the body mass index (BMI). Seventy nine menopausal women, 27-72 years old (53,2±0,9 years) were examined and serum leptin levels were determined, with IRMA method. Our results are: (a) serum leptin levels varied between 5,8 ng/ml and 50,9 ng/ml (22,4±1,1ng/ml), (b) serum leptin levels showed high positive correlation, (r=0,488, p<0,0001), to the BMI, whereas there was no correlation to the age of the menopausal women and to the duration of the postmenopausal period. The results of this study indicate that body mass index (BMI) is the main variable which influences serum leptin levels.

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Pharmaceutical conversion of paroxysmal atrial fibrillation; quinidine or amiodarone?

Hippokratia 1999, 3(2): 77 - 81

G Boudonas, D. Psirropoulos, A. Efthimiadis, G. Kazinakis, M. Parthenis, C. Keskilidis, N. Lefkos

Abstract

The aim of the study was to investigate the effectiveness of quinidine (QY) and amiodarone (AM) on paroxysmal atrial fibrillation (PAF) conversion.Methods: 476 patients who admitted because of recent onset (<24 hours) PAF were studied. Patients were randomly divided into two groups, age and sex matched. Group A comprised 337 patients who were treated with QY in combination with digoxin and group Β 139 patients who were treated with AM. In the case where PAF was not converted into sinus rhythm with the one drug, an attempt to conversion with the other drug was undertaken. The Q-Tc interval was determined before and after PAF conversion.
Results: With the administration of QY (group A) conversion of PAF into sinus rhythm achieved in 312 (92.6%) patients and with the administration of AM in 23 of the remaining 25. In group Β patients, conversion of PAF with AM achieved in 122 (87.8%) and with the administration of QY in 13 of the remaining 17. The Q-Tc interval was measured in all patients in the after conversion ECG but only in a minority in the initial ECG, attributed to the difficulty of accurate Τ wave end determination because of fibrillation. Although there were no statistically significant differences of Q-Tc interval duration between the two group of patients (412.7±21.9 msec in group A and 417.6±31.2 msec in group B), in the subgroups of patients who were not converted with the initially administered drug, a statistically significant difference in Q-Tc interval duration was found. Especially, in the subgroup of patients who were not converted with the initial administration of QY and digoxin the duration of Q-Tc was significantly smaller compared with that of patients who were not converted with the initial administration of AM (392.8±15.9 msec and 432.1±21.3 msec respectively, p<0.001).Conclusions: QY and AM are strong antiarrythmic agents in PAF conversion, both effective and safe; but in a small proportion of these patients, the extreme values of Q-Tc interval duration may predict the conversion of PAF into sinus rhythm by either QY or AM.

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Skin and Psychiatry from the point of view of a dermatologist

Hippokratia 1999, 3(2):82-85

D. Ioannides

Abstract

Dermatologic diseases often present with psychiatric manifestations, which sometimes must be treated.
Diseases of the skin, often associated with psychologic manifestations are atopic dermatitis, psoriasis, alopecia areata, acne, vitiligo and vulvor disease. The role of psychiatric intervention is discussed in these cases

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Studies on the mechanism of action of cyclosporine on liver regeneration after 2/3 partial hepatectomy in rats

Hippokratia 1999, 3(2):86-87

I. Fouzas

Abstract

The effect and the precise mechanism of action of cyclosporine (CsA) on the regenerative capacity of the liver has not been elucidated. Previous findings in the experimental model of 2/3 partial hepatectomy (PH 2/3), in the rat, support the theory that liver regeneration is controlled by specific immume mechanisms. Therefore, we considered worthwhile to dissect the possibility that CsA intervenes in the immune reaction to the regenerating liver through its influence to hepatocytes as antigen presenting cells (APCs), by studying a) the effect of CsA on liver regeneration, b) the effect of SC-19220 on the influence of CsA on liver regeneration and c) the expression of class I and II MHC molecules on regenerating hepatocytes. CsA (20 mg/Kgr, 4 days pre-op and 1 day post-op) augmented liver regeneration, 48h after PH 2/3, in wistar rats. This was proved by the increase of DNA synthesis in isolated hepatocytes (p<0.05), by flow cytometry after BrdUrd administration (2x50 mg tab, SC, at 18 and 42 h post-op), as well as of the number of mitosing hepatocytes / 50 HPFs (p<0.05). Moreover, it was found that CsA increases DNA synthesis in the sham operated animals (p<0.001), although there were no mitoses in the first 48 h post-op.The IP administration of SC-19220 (5 mg bolus and 20 mg by an osmotic minipump for 48 h), inhibited, very significantly, the augmenting action of CsA on DNA synthesis (p<0.001), labeling index (p<0.001) and number of mitosing hepatocytes / 50 HPFs (p<0.01).Flow cytometry analysis of the isolated normal rat hepatocytes showed medium grade expression of class I and very low but detectable expression of class II MHC molecules. PH 2/3 induced the expression of class I and II MHCs by the regenerating hepatocytes (p< 0.01) and this was reduced by CsA (p< 0.01), although there was only a small, not significant, increase in DNA synthesis (p> 0.05).PH 2/3 induced the levels of SGOT (p<0.001) which were reduced by CsA (p< 0.05). PH 2/3 increased the levels of alkaline phosphatase (p<0.01), blood urea nitrogen (BUN) (p<0.01) and serum creatinine (Scr) (p<0.001) and they were increased further by the administration of CsA. Total bilirubin levels were not affected by 2/3 partial hepatectomy, CsA or SC-19220. The administration of CsA increased, very significantly, the levels of glucose in the sham operated rats (p<0.001).In conclusion, the augmenting action of CsA on hepatocyte proliferation is indirect and can be attributed to an increase of PGE2 synthesis, through its action on EP1 receptor. CsA reduces, also, the immunogenicity of the regenerating liver by inhibiting the expression of class I and II MHCs by the regenerating hepatocytes, although this had no effect on DNA synthesis. At 48 hours after partial hepatectomy, it was probably too early for the cytotoxic immune response to have any impact on liver regeneration and its inhibition by CsA could not have any augmentive effect. This is supported by the fact that light microscopy showed no inflammatory infiltrate or necrosis in the liver lobules and portal tracts of the hepatectomized animals. The reduction of the levels of SGOT after PH 2/3 can be considered as an additional protective influence of CsA on the liver remnant.

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