Reconstruction of full thickness postburned dermal defect with "artificial skin" in childhood

Hippokratia 2000, 4(3):99-104

I. Frangou, K. Manos, V. Lambropoulos, Ch. Kasselas, A. Philalithis, Ch. Chaidos, M. Papoutsakis, M. Tamiolaki, V. Kasselas

Abstract

Integra Artificial Skin (I.A.S.) was first introduced by Burke and Yannas in 1981 and it is a permanent dermal regeneration template. Integra is a natural material consisting of a net of bovine tendon collagen fibers and chondroitin -6- sulfate from sharks, covered by a solid silicone sheet. It was used, on a 6 months old infant, suffering from full thickness burn in face, left hand and part of thumb and index finger of the right hand, in the Pediatric Surgery Unit of Hippocratio General Hosp. of Thessaloniki, Greece. This was the first time Integra was applied in a child in Greece. On the third postburn week the burned areas were debrided and covered with Integra Artificial Skin. Four weeks later, when dermal regeneration occurred, the silicone sheet was easily removed and the neodermis was skin-grafted with autologous extremely thin skin grafts, taken from both feet. There was a 100% take of Integra and skin grafts, although there was a high risk of infection because of delay. Recovery was uncomplicated. The purpose of this study is to analyze the technique of Integra application, and its perspective and to review the literature.

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Cesarean Section and Anesthetic Management of Parturients with Non-obstetric Disorders

Hippokratia 2000, 4(3):105-120

V. Sdrani, M. Goutzioulis

Abstract

The selection of the anesthetic methods during cesarean section is determined by a number of parameters. One important of the latter is the presence of obstetric complication to parturients, as preeclampsia or non-obstetric as mitral stenosis. Other parameters that determine the anesthetic technique for cesarean section are the indications of the obstetricians and pediatrists, the experience of the anesthesiologist as well as the emergency or not of the operation.
The anesthetic methods that are used today are the general anesthesia with intravenous administration of anesthetic drugs and the regional anesthesia - epidural or spinal - with neural block. In normal parturients regional analgesia is indicated for pain delivery and the regional anesthesia for cesarean section.The aim of this article is to describe the indications and parameters that determine the selection of the appropriate anesthetic methods for elective or emergency cesarean section in parturients with non-obstetric disorders such as pulmonary, cardiac, endocrine, gastrointestinal tract and blood diseases. Furthermore, rarer disorders of parturients are discussed such as neoplasms, muscle and myoneural junction diseases, HIV infection, organ transplantation and substance abuse.

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Dyslipidemia in nephrotic syndrome

Hippokratia 2000, 4(3):121-127

P. Pangidis

Abstract

Dyslipidemia in nephrotic syndrome is closely related with the degree of proteinuria and hypoalbouminemia. On the other hand, the underlying glomerular pathologic lesion seems to play no important role.Increased levels of total cholesterol, triglycerides, phospholipids, Lp (a), LDL, IDL and often VLDL are found, whereas changes in HDL levels are still under discussion.The lipid metabolism disorders can be explained by multifactorial pathogenetic mechanisms, such as enhanced hepatic synthesis of lipoproteins, decreased or diverse lipoprotein catabolism and loss of a liporegulatory substance in the urine.Changes of lipoprotein levels are reversible, following disease-specific treatment. Drugs, such as nicotinic acid, cholic acid binders, fibric acid derivatives and HMG CoA reductase inhibitors (statins), are currently used. Nevertheless, the question: what treatment, to which patient, for how long, still remains controversial.

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Obesity and its effect on reproductive function

Hippokratia 2000, 4(3):128-135

DK. Panidis, FV Gkoutzioulis

Abstract

Obesity has significant consequences for the reproductive system, depending upon the amount and distribution of body fat. Epidemiological evidence clearly shows that being overweight contributes to menstrual disorders, infertility, miscarriage, poor pregnancy outcome, and impaired fetal well-being. Central adiposity is particularly important in clinical sequelae associated with an increased body mass index. The advent of assisted reproduction highlights the problem of being overweight, and the use of gonadotrophins in ovulation induction and in vitro fertilization is more difficult when the subject is overweight. Weight loss has marked effects on improving the menstrual cycle and promoting spontaneous ovulation and fertility. The mechanisms for this are unclear, but may be associated with changes in sensitivity to insulin..

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Gas containing gallstones. Star or Mercedes-Benz sign

Hippokratia 2000, 4(3):136-140

A Stefanidis, P. Kougias, A. Zografos, M. Vagenas, P. Tsoutsas, K. Chrisafis

Abstract

Gas within the lumen of Gallbladder can be due to emphysematous chelecystitis, fistulas between the gallbladder and bowel or the existence of gas containing gallstones. Gallstones remain a widespread clinical problem. Though infrequently seen, a characteristic finding of gallstones is the "star" sign or "Mercedes - Benz" sign. Stellate radiolucencies within a gallstone produce a triradiate pattern resembling the insignia of Mercedes-Benz automobile. Ultrasound is now the major imaging modality for demonstrating gallstones. CT seems to delineate better the quantity of air inside the stones. A rare case of an adult man with stellate fissuring - gas containing gallstones and colonic carcinoma is described.

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