Dental enamel defects in first-degree relatives of children with coeliac disease

Hippokratia 2000, 4 (4): 147-151

P. Thanoulis, S. Karida-Kavalioti, S. Stefanidis, P. Augustidou-Savopoulou, F. Kanakoudi-Tsakalidou, S. Herakis, A. Genalis

Abstract

It is known that denial enamel defects are present in children with coeliac disease. Similar defects have been reported in adults with coeliac: disease. The aim of this study was to find out whether dental enamel defects can be used to screen for coeliac disease among apparently healthy first-degree relatives of coeliac disease children. 54 healthy first-degree relatives of 27 children and adolescents with coeliac disease, aged 4-55 years, 35 parents and 19 siblings, were studied. The dental examination was performed using the dmf and DMF incides and dental enamel defects were evaluated using the modified DDE index. In all relatives antigliadin (AGA), antireticulin (ARA) and antiendomysium antibodies (EMA) were estimated. Dental enamel defects were found in 5 out of 54 relatives (9%). All of them had normal titer of AGA and negative ARA and EMA. From the remaining 49 relatives, only 1 had increased titer of AGA and positive ARA and EMA, and small bowel biopsy showed typical lesions of coeliac disease.In conclusion, dental enamel defects in the first-degree relatives of coeliac disease children are not unusual but were not found to be correlated with the presence of positive antibodies to coeliac disease.In our opinion, first-degree relatives should be frequently referred to a gastroenterologist for an examination and the role of dentists is important in screening patients possible suffering from atypical coeliac disease.

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Large bowel Candidiasis with diarrhea

Hippokratia 2000, 4(4):152-156

F. Karasavvidou, G. Georgiou, D. Kirmizis, N. Flaris, E. Bibasi, E. Alexopoulos, M. Leontsini

Abstract

Candidiasis is the most frequently encouniered fungal infection in patients with cancer and immunocompromised patients. Gastrointestinal candidiasis is being recognized more commonly in recent years. Esophagus and stomach are the most frequently affected organs. Large bowel infection and diarrhea due to Candida overgrowth is uncommon.We report a case of a 70-year-old, immunocompromised woman, with chronic renal failure and nephrotic syndrome due to membranous glomerulonephritis. During her hospitalization, respiratory tract inflammation was diagnosed and antibiotic therapy was given. Ten days after her hospitalization, although she was still on antibiotic therapy, she developed watery diarrhea. Colonoscopy was performed and biopsies were taken. Candida albicans was isolated in stool cultures. Colonoscopy showed edematous mucosa, segmental ulcers and haemorrhagic areas. Histological examination of biopsies showed extensive ulceration of the mucosa with fibrin exudate and haemorrhage. Within the fibrin exudates fungal parasites were seen. The patient died of sepsis. Autopsy was not performed.In suspected cases of fungal colitis in immunocompromised patients the diagnosis should be established by biopsy.

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Prostatic specific antigen and its usefulness in clinical practice

Hippokratia 2000, 4(4):157-162

V. Rombis, S. Touloupidis, G. Fatles, E. Balaxis, K. Vakalopoulos

Abstract

Many advances have occurred during the last decade in the clinical use of prostate specific antigen (PSA) for detecting, staging and monitoring prostate cancer. We review the clinical usefulness of serum PSA as a tumor marker of prostate cancer.The international literature was reviewed from 1986 to 1999.Although controversial, age specific PSA reference ranges can improve the sensitivity for prostate cancer detection in young men and the specificity in older men. Percent free PSA improves the specificity for prostate cancer detection in men with PSA values between 4 and 10 ng/ml, and a PSA density of greater than 0.15 may better distinguish benign prostatic hyperplasia from prostate cancer. PSA velocity can improve the ability to detect prostate cancer when 3 serial PSA values are measured during a 2-year period. PSA is the most clinically useful tumor marker to monitor recurrence of disease after treatment of prostate cancer. PSMA and RT-PCR are relatively new promising laboratory methods detecting prostate cancer cells in the blood or bone marrow.PSA remains the best and most widely used tumor marker in urology today but there is lot of ambiguous spots to be turnout.

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Comparing the results of endovascular treatment of the abdominal aortic aneurysm (AAA) during two consecutive periods of time

Hippokratia 2000, 4(4):163-169

K. Papazoglou, A. Mpalitas, G. Trellopoulos, G. Sfyroeras, A. Ntinas, N. Antoniadis, H. Pezikoglou, D. Giakoustidis, E. Giakoustidis

Abstract

The aim of this study is to present the results of endovascular treatment of the AAA during two periods of time. In 5 years, 131 patients were treated for an AAA. These patients were classified in two groups: A) treatment in the first two years of practice of this method (n=50) and B) treatment the next 3 years (n=81). These groups were similar regarding the age of the patients, the risk factors, and the anatomic features of the AAA, except the cases with large angle of the proximal neck and kinking of iliac arteries which were prevailing in the second group. The used grafts during the 1st period were home made stent grafts of PTFE with a frame of Ζ Gianturco stent, and the ones used during the 2nd period were the commercial devices AneuRx (46,9%), VanGuard (4,9%), Talent (1,2%) and home made (46,9%). 44% of the grafts were tubular in the 1st period and 12,3% in the 2nd, 44% and 72,8% were bifurcated respectively. Aortoiliac with a femo-femoral bypass was used in 12,3% of the A group and 14,8% of the Β group. Local anesthesia was used in 92% of the patients of the A group and in the 67,9% of the Β group, in the remaing patients a regional anesthesia was prefered. There was an attenuation of the operational incidents (from 18% to 12%), of the postoperative complications (from 14% to 12,3%) and an imporant reduction of endoleaks (38% in A group, 11,1% in Β group). The blood transfusion and the duration of hospitalisation were similar in the two groups. The amelioration of the devices and the growing experience lead to a more reliable endovascular treatment of the AAA. Although there are still some medical complications happening mostly during the learning of this method, and some self-induced dangers, which determinate the results.Fatty infiltration of the liver occurs in response to various toxic and metabolic insults. The liver occupies a central position in lipid metabolism. Disruption of one or more steps in hepatic lipid metabolism may result in abnormal accumulation of triglycerides in the hepatocytes.
Fatty change of the liver usually is a diffuse process involving the entire organ. Focal sparing in an otherwise diffusely fatty infiltrated liver may simulate metastasis, a primary neoplasm, an abscess or other tumorous of infectious involvement of the liver.In nine patients ultrasound demonstrated fatty infiltration of the liver with diffuse increased echogenicity except for a solitary hypoechogenic area. The final diagnosis was confirmed by CT examination and the fine needle aspiration cytology and histology of these hypoechoic areas.

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Evaluation of the diagnostic and therapeutic manipulation of the upper gastrointestinal system in Primary Health Care

Hippokratia 2000, 4(4):170-178

ED. Zogas, X. Tsiolis, V. Zoga, N. Eleftheriou

Abstract

The purpose of this work was the registration and the evaluation of the diagnostic and therapeutic manipulations which are applied to treat the diseases and symptoms of the upper digestive system at the first level health system.Population study and Methods: 164 adults were investigated, 62 men and 102 women by means of a specific questionnaire, and personal interview. These subjects presented a disease or a symptom of the upper digestive system for which they received with or without a doctor's consultation, systematically antiulcerative treatment.Results: (a) 42,68% of chronic antiulcerative treatment aimed at the reduction of symptoms of the upper digestive system.(b) The diagnosis of 34,42% of the sufferers was based on X-rav examination, the 14,28% on endoscopic on defection of Helicobacter pylori (Hp) tests 51,30% on clinical examination. (c) 10,30% was subjected to treatment for the removal of Hp. (d) One in two men and three in four women were informed about the duration of the treatment they had to follow. (e) Only the 20,78% had been reexamined during the treatment period. Conclusions: The applied diagnostic and therapeutic management the diseases of the upper digestive system at the first level health system is thought as inadequate since in its totality do not follow the modern therapeutic trends and as a result the patients overconsume antiulcerative medication.Thus it is required by doctors of Primary Health Care to be continuously informed and be in a position to confront efficiently the requirement of our time.

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Simulated tumors of the periportal area during the sonographic examination of liver with diffuse fatty infiltration

Hippokratia 2000, 4(4):179-185

A. Stefanidis, T. Theodoridis, E. Karoglou, A. Gavriilidou, C. Liouliakis, N. Fotiades, E. Soilemezi

Abstract

Fatty infiltration of the liver occurs in response to various toxic and metabolic insults. The liver occupies a central position in lipid metabolism. Disruption of one or more steps in hepatic lipid metabolism may result in abnormal accumulation of triglycerides in the hepatocytes.Fatty change of the liver usually is a diffuse process involving the entire organ. Focal sparing in an otherwise diffusely fatty infiltrated liver may simulate metastasis, a primary neoplasm, an abscess, other tumor, or infectious involvement of the liver.In nine patients ultrasound demonstrated fatty infiltration of the liver with diffuse increased echogenicity except for a solitary hypoechogenic area. The final diagnosis was confirmed by CT examination and the fine needle aspiration cytology and histology of these hypoechoic areas.

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