Chronic Obstructive Pulmonary Disease

Hippokratia 2000, 4(1):3-13

G. Ilonidis

Abstract

Chronic obstructive pulmonary disease (COPD) is a major worldwide health problem that has an increasing prevalence and mortality. In North America and the European Union is the fourth leading cause of death.The chronic obstructive pulmonary disease includes at least three covered lugn diseases: a. Emphysema, b. Chronic bronchitis, c. Bronchiolitis.The major characteristic of COPD is the presence of chronic airflow limitation that progresses slowly over a period of years and is by definition largely irreversible.Another characteristic of COPD is the loss of elastic recoil pressure, the destruction of lung parenchyma, the chronic inflummation, the increased wall muscle mass and the fibrosis in bronchiolar under 2 mm diameter..

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Decompression sickness

Hippokratia 2000, 4(1):14-18

Th. Mesimeris

Abstract

Decompression sickness (DCS) is due to formation of air bubbles in tissues and blood, following rapid reduction of the environmental pressure. DCS includes every clinical syndrome following inadequate decompression. Type I DCS is characterized by mild clinical symptoms such as limb pain, lymphatic and cutaneous manifestations. Type II DCS is characterized by severe neurological and cardiorespiratory symptoms or even shock, and can sometimes be fatal. Arterial gaseous embolism, following pulmonary overinflation, is the most serious diving accident and is considered as type III of DCS. Intravascular air bubbles interact with endothelium and blood constituents, leading to a) increased capillary permeability, extravasation and hemoconcentration, b) activation of the coagulation cascade and DIC (disseminated intravascular coagulation) and c) denaturation of plasma proteins. These alterations result in serious impairment of the microcirculation and severe ischemic tissue damage. The treatment of DCS consists of recompression in a hyperbaric chamber, in order to minimize air bubble size through the increased ambient pressure and hyperbaric oxygenation of the cells. An equally important goal of the treatment of the DCS is the restoration of the intravascular fluid volume and the rheological properties of blood.

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Preoperative localization of parathyroid glands in secondary hyperparathyroidism and concomitant thyroid disease

Hippokratia 2000, 4 (1): 19-25

N Sikas, D Gakis, D Takoudas, G Vergoulas, I Fouzas, N Karatzas, A Antoniadis

Abstract

99m?Tc-sestamibi and ultrasound are the most commonly used methods for the preoperative localization of parathyroids in patients with secondary hyperparathyroidism. The aim of this study was to assess the value and usefulness of parathyroid preoperative localization in secondary hyperparathyroidism, in the presence of coexistent thyroid disease. Between 1996 and 1998, seventy two 72 parathyroidectomies for secondary hyperparathyroidism were performed. In 10 patients we found concomitant thyroid disease (14%). For the preoperative localization we used ultrasound and 99m?Tc-sestamibi scan.Ultrasound revealed 19 parathyroid glands (50%) out of the 38 that were surgically removed.Their mean weight was 0.738 gr vs. 0.438 gr of those not detected (p=0.21) and the mean size was 1.221 cm vs. 0.973 cm (p=0.21) respectively. 99m?Tc-sestamibi demonstrated 17 glands (45%) with a mean weight of 0.836 gr vs. 0.387 gr of the glands not demonstrated (p<0.05) and a mean size of 1.294 cm vs. 0.938 cm (p<0.05) respectively. Two glands were not found. Only 10 parathyroid glands (26.3%) were identified simultaneously by both ultrasound and 99m?csestamibi (mean size 1.38 cm and mean weight 0.991 gr). Ultrasound demonstrated the superimposed thyroid disease in all 10 patients (100%), while 99m?c-sestamibi only in 3 (33%). The histology of the parathyroids was predominantly nodular hyperplasia in those glands detected with 99m?Tc-sestamibi. Nodular goiter was the predominant lesion of the thyroid gland. Both studies, when they are used alone, have shown relatively low sensitivity (45% with 99m?Tc sestamibi and 50% with ultrasound) in detecting parathyroid glands in secondary hyperparathyroidism and concomitant thyroid disease. Ultrasound scan can give information for the thyroid disease and it can be the first and sometimes the only study in every patient with secondary hyperparathyroidism undergoing neck exploration for a first time.

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Tuberculosis in patients with renal transplantation

Hippokratia 2000, 4(1): 26-32

G Miserlis, G. Vergoulas, M. Leontsini, D. Gakis, A. Papagiannis, V. Papanikolaou, G. Imvrios, D. Takoudas, A. Antoniadis

Abstract

Five (three men) out of 366 patients with renal transplantation presented TBC between February 1987 and August 1997. Patient?s mean age was 49 years (range 41-52 years) and their mean follow up from transplantation was 6l months (range 12 - 127 months). Four of them had received a cadaveric graft and quadruple sequential induction therapy and one had a living related donor and had received triple drug immunosuppression. The mean time of TBC diagnosis from the day of transplantation was 44 months (range 4 - 119). Two of them had a positive past history for TBC disease. The location of TBC disease was the renal graft in one, the central nervous system (TBC meningoencephalitis) in another and the respiratory system in three patients. Two of the patients with pulmonary TBC presented TBC of the renal graft and the diagnosis was made after a renal biopsy. Three patients received triple anti-TBC therapy and two quadruple. In one patient there was early discontinuation of treatment because of liver dysfunction. From the remaining four patients two lost their renal graft and the other two died. In conclusion, TBC in transplanted patients is a dangerous infection that can cause graft or patient loss. Renal graft biopsy can be useful in the diagnosis of this disease.

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Long-term administration of conjugated estrogens to women with surgical menopause: effect on serum lipids

Hippokratia 2000, 4(1):33-38

A. Kourtis, K. Makedou, A. Hitoglou, M. Kourti, I. Kalahanis, D. Panidis

Abstract

This prospective study was designed in order to estimate the influence of long-term conjugated estrogen administration (24 months) upon total serum cholesterol (TC), HDL-cholesterol, LDL-cholesterol and triglyceride (TG) levels. Eighteen women, aged from 46 to 64 years, who had total hysterectomy and bilateral salpingho-oopho-rectomy for benign surgical indications, 1-300 months ago, were studied. At 9 a.m, blood samples were drawn and the serum TC, HDL-, LDL-cholesterol and TG levels were determined. The next day, conjugated estrogens (Premarin?), in a dose of 0.625 mg per day, were administered for a period of two years. Blood samples for the determination of the previously mentioned parameters were drawn 1, 2, 3, 6, 9, 12, 18 and 24 months after Premarin? administration. It was found that: a) TC levels were significantly decreased within 9 months from the beginning of the treatment, b) HDL levels were progressively elevated with a statistical significance at 6, 9 and 24 months, c) LDL levels were significantly decreased within the first 12 months and then they were elevated at their baseline value, and d) TG levels did not substantially vary. Our results lend further support to the view that long-term conjugated estrogen administration is favorable to lipid metabolism and, consequently, it may have a counter effect upon the cardiovascular diseases risk factors.

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Assessment of Quality of Life.Nottingham Health Profile (NHP)-Greek version

Hippokratia 2000, 4(1):39-42

A. Vidalis, M. Syngelakis

Abstract

This article presents the Greek version of the N.H.P, an internationally recognized, valid, reliable and easy to use tool, to evaluate an individual's quality of life.The Nottingham Health Profile (N.H.P), is a self-administered questionnaire consisting of 38 [7] simple questions related to the individual's health condition.It is a valuable source of information concerning six issues (mobility, pain, sleep, energy, emotional reactions, social isolation) and seven sectors of the individual's every day life (work, housing, social life, family life, hobbies and vacations), which can be seriously affected by a morbid condition.
Its Greek version intends to provide researchers with an additional tool of evaluating the impact which an illness or handicap may have, upon the quality of life of Greek patients.

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