Laparoscopic management of a large solitary nonparasitic cyst of the liver in an elderly patient

Hippokratia 2001, 5 (4): 147-150

G Frangandreas, D Giakoustidis, K Patsiaoura, D Tsantilas, T Gerasimidis

Abstract

Solitary cysts of the liver are rare lesions especially in elderly patients and they are diagnosed incidentally after abdominal US or CT scan. We present a case of a solitary benign cyst of the liver in an 80-year-old male patient that was treated laparoscopically with partial cystectomy (wide unroofing) using the ultrasound sears. The patient was admitted to our department with mild symptoms, consisting mainly of abdominal discomfort, during the previous year. He was subjected to laparoscopical wide unroofing, he had an uneventful postoperative course and was discharged at the third postoperative day. The aim of the presentation is to emphasize the rarity of this pathological condition in the elderly patients, to analyze the technical feasibility of such management and to evaluate the safety and outcome of the procedure.

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The Duhamel-Martin operation in adult Hirschsprung's disease performed with mechanical sutures

Hippokratia 2001, 5 (4): 151-155

A Sakadamis, K Ballas, A Papavasiliou, C Pasinis, S Rafailidis

Abstract

The Duhamel-Martin operation is widely used for the treatment of adult Hirschsprung's disease. Purpose of this article is to represent our technique in performing this procedure using mechanical sutures entirely. We performed the operation, as a single or staged procedure in three patients. There were not major postoperative complications and the long-term results were excellent.We believe that the use of mechanical sutures in the Duhamel-Martin operation makes the surgical procedure easier and the total operating time as well as mean hospital stay is minimized. The technique can be recommended in every case of adult Hirschsprung's disease.

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Losartan versus Valsartan in the treatment of hypertension of renal transplant recipients

Hippokratia 2001, 5 (4): 156-164

G Vergoulas, Gr Miserlis, V Papanikolaou, D Gakis, I Katsara, E Atmatzidis, D Takoudas, A Antoniadis

Abstract

Arterial hypertension is a major risk factor for cardiovascular morbidity and mortality in renal transplant recipients. Steroids, cyclosporine A (CsA) and FK-506 contribute in the development of hypertension. Losartan and Valsartan, angiotensin II receptor type 1 antagonists (AT1), have been proved to be effective antihypertensive agents in the general population and in the renal transplant recipients. The purpose of the present retrospective study was to compare the safety and efficacy of losartan (L) and valsartan (V) in the treatment of hypertensive renal transplant (Rt) recipients.Sixty four renal transplant recipients on antihypertensive therapy were included in the study because of inadequate blood pressure control, drug side effects or proteinuria. Three patients were withdrawn from the study because of inappropriate serum creatinine elevation. Forty patients (28 men), 41 years old, received L3.86 years after renal transplantation at the dose of 25-100 mg/d and 21 patients (16 men), 41 years old, received V 4.21 years after renal transplantation (p:NS) at the dose of 80-160 mg/d. Systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine levels (CRs), K, uric acid, Ht and Hb were recorded before and every two months for a period of six months after L or V initiation. Proteinuria, number of antihypertensive agents, cyclosporine A (neoral) dose and blood levels were recorded before and at the end of the six month period. The percentage of abnormal blood pressure readings was calculated before and during the patients follow up. Doubly multivariate repeated measures analysis of variance, repeated measures analysis of variance, Mc Nemar and independent t tests were used for statistical analysis.
Multivariate analysis showed that patients on V had statistically significantly (ss) lower DBP compared with patients on L (p: 0.037). SBP/DBP was 145.17±15.78/91.60±9.72 mmHg, 138.03 ±10.74/87.14±7.98 mm Hg, 142.00±15.67/ 88.57±7.68 mmHg and 143.03±14.85/ 90.35±8.15 mmHg before 2, 4 and 6 months on L treatment respectively (pins/NS). SBP/DBP was 153.50±12.25/90.5±9.71 mmHg, 142.00 ± 9.92 / 85.25±6.78 mmHg, 137.25 ± 10.93 / 85.75±6.74 mmHg and 133.25±8.92/84.00±5.98 mmHg before 2, 4 and 6 months on V treatment respectively (p:0.0005/NS). The number of abnormal blood pressure readings was reduced ss in the V group (p: 0.001). The number of antihypertensive agents per patient was 2.00+0.87/2.09±0.83 before (L/V) and 1.67 ± 0.85 (p:0.001)/1.47±0.60 (p.0.001) after 6 months (L/V). CRs was 1.61 ±0.81/1.28±0.32 mg/dl, 1.64±0.77/1.36±0.36 mg/dl, 1.66±0.86/1.40±0.37 mg/dl and 1.68±0.88/l.34±0.32 mg/dl before 2, 4, and 6 months on L/V (p:NS/0.036) treatment respectively. Hb was 13.63±2.72/13.15±2.05 g/dl, 13.39+2.28/12.65±1.93 g/dl, 13.00±2.18/12.51±2.01 g/dl and 12.85±2.26/ 12.55±2.10 g/dl before 2, 4 and 6 months on L/V (p:0.002/0.002) treatment respectively.Valsartan is more potent than losartan as far as the reduction of DBP in the recommended doses and reduces ss the high abnormal blood pressure readings. L and V control efficiently SBP and DBP of hypertensive Rt recipients, lower significantly the need for other antihypertensive agents and cause significant fall of Hb.

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Angiotensin II type 1 receptor antagonists reduce proteinuria of hypertensive renal transplant recipients

Hippokratia 2001, 5 (4): 165-171

G Vergoulas, Gr Miserlis, V Papanikolaou, F Karasavvidou, M Leontsini, D Gakis, A Pantzaki, E Atmatzidis, D Takoudas D, A Antoniadis

Abstract

The aim of this study was to investigate the safety and efficacy of angiotensin II receptor type 1 antagonists (AT1RA) on hypertensive renal transplant recipients with proteinuria. Eighteen pts with hypertension and proteinuria were included in the study. These pts (14 male, 4 female) with a mean age 48 years (range 31 to 64 years) received AT1RA (11 losartan, 7 valsartan) 4.33 years after Rt (0.5 to 11 years). All of them had a six month follow up before and after the initiation of AT1RA. Systolic (SBP) and diastolic blood pressure (DBP), serum creatinine (Scr) and Hb were recorded every two months during the follow up period. Proteinuria (Pr), number of antihypertensive agents (NAA) and cyclosporine levels (CyAl) were recorded at AT1RA treatment initiation and six months later. ANOVA for repeated measures and paired sample t test were used for statistical analysis. SBP/DBP measurements were 143.12±14.00/ 90.31±10.07 mmHg, 146.87±10.62/ 90.00±7.30 mmHg, 148.12+12.63/93.75±8.85 mm Hg, and 146.25±13.96/ 86.25±5.91 mmHg 6, 4, 2 and 0 months before AT1RA initiation respectively (p:NS) and 139.33±14.8/85.33±5.49 mmHg, 143.66±17.05 /86.00±8.06 mmHg and 142.33±10.99/87.33+8.42 mmHg 2, 4 and 6 months after AT1RA initiation respectively (p:NS). Scr was 1.53+0.55 mg/dl, 1.6l±0.70 mg/dl, 1.66+0.70 mg/dl and 1.68+0.71 mg/dl 6, 4, 2 and 0 months before AT IRA initiation respectively (p:NS) and 1.78±0.80 mg/dl, 1.84±0.87 mg/dl and 1.82±0.94 mg/dl 2, 4 and 6 months after AT1RA initiation respectively (p:NS). Hb was 12.80±2.11 g/dl, 12.57±1.78 g/dl, 12.73 ± 1.80 g/dl and 12.26+2.09 g/dl 6, 4, 2 and 0 months before AT1RA initiation respectively and 12.10±1.69 g/dl, 11.48±1.59 g/dl and 11.55±1.62 g/dl 2, 4 and 6 months after AT1RA initiation respectively (p:0.005). Pr was 0.76+0.77 g/dl g/24 h before and 0.61±0.63 g/24 h six months after AT1RA initiation (p:0.024). The NAA was 2.27+0.89 and 1.83+0.85 before and six months after AT1RA initiation (p:0.007). CyAl were 83.75±42.22 and 70.24±40.16 ng/L before and after AT1RA treatment (p:NS). In conclusion AT1RA reduce statistically significantly renal transplant recipient's proteinuria, control their hypertension efficiently, reduce the number of antihypertensive agents needed, do not cause impairment of renal function and cause a small but statistically significant fall of Hb.

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The IL-6 value in the differential diagnosis of the exudative pleural effusion

Hippokratia 2001, 5 (4): 172-175

A Christopoulos, Ath Notopoulos, G Liaros, Ir Katsarou, P Andricacos, E Phegou, O Drakoulogona, L Panteli, E Mendrinou

Abstract

Interleukin 6 (IL-6) is locally produced at the sites of inflammation of the pleural space. It is also known that some malignant cells produce IL-6. Pleural IL-6 leaks to systemic circulation and causes systemic effects. In this study we measured IL-6 in serum/pleural fluid paired samples in various groups of patients with exudative pleural effusions. In the serum were detected significantly higher IL-6 values in patients with parapneumonic effusions (n=32, mv 12.3±6.lU/ml) in comparison to tbc effusions n=23 mv 4±3 U/ml, (p=0.00464) as well as to malignant effusions n=20, mv 5.4±3.9U/ml (p=0.02). In the pleural fluid the tbc effusions presented with significantly higher IL-6 values (mv 498±276 U/ml), in comparison to malignant effusions (mv 42+56.2 U/ml), (p=0.0046) as well as to parapneumonic effusions (mv 244±192 U/ml), (p=0.01). The serum/pleural IL-6 ratio, was: 1) tbc effusions 0.02, 3) malignant effusions >0.1. Ninety six per cent of the malignant effusions were presented with a pleural fluid's IL-6 value < 100 U/ml, whereas all the empyemas and the tbc effusions were presented with a value > 100 U/ml. These results suggest that the serum/pleural fluid's IL-6 ratio (IL-6 criterium) together with pleural fluid's IL-6 values can lead to quick differential diagnosis of the exudative pleural effusion, which will be confirmed later with the traditional practice methods.

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