Surgery of the Nasal Valve.Aesthetic and functional surgery of the anterior part of the nasal septum

Hippokratia 2002, 6 (3): 99-104

I konstantinidis, St. Triaridis, Ath. Triaridis, N. Benis, D. Tsitlakidis, K. Karagiannidis

Abstract

Nasal valve is a very important structure of the nose from the functional point of view. Deviation of nasal septum at the level of the vestibule as well as nasal valve dysfunction are common causes of nasal obstruction symptoms and frequent causes of nasal tip and columella deformities. During a 7-year period, 1258 patients underwent septal surgery at the ENT Department of Hippokratio General Hospital. One in five of those patients had suffered preoperatively from nasal obstruction symptoms caused by deviation of the caudal (anterior) part of nasal septum. In 60% of patients with nasal valve problems, obstruction was unilateral while history of previous trauma or surgical intervention was recorded in almost half the cases. All patients underwent surgical correction of the anterior part of the nasal septum with a variety of surgical techniques, according to the underlying pathology. This study presents our techniques, complications, aesthetic and functional results of each technique. Surgeons must always keep in mind the significance of the caudal end of the septum and the valve area for the normal airflow in the nasal cavity.

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Kaposi's Sarcoma of the Bulbar Conjuctiva

Hippokratia 2002, 6 (3): 105-110

F. Karasavvidou, CH. Karkavelas, E. Panousi, N. Georgiadis, D. Mikropoulos, K. Papadimitriou

Abstract

We report a case of Kaposi's sarcoma of the bulbar conjunctiva in a 70 years old man. The patient was HIV negative and had not any other disease of the immune system.The lesion appeared as a pedunculated, nodular mass on the left bulbar conjunctiva. The patient had a history of cataract operation on the same eye one year ago.Surgical excision and pathological examination was performed.Microscopically it was composed of spindle cells with no pleomorphism or high mitotic activity. The spindle cells formed slits containing extravasated red blood cells and were CD34 and Ulex Europeaus positive.Kaposi's sarcoma is a spindle cell malignancy of endothelial cell origin. It is a frequent tumor in patients with the acquired immunodeficiency syndrome (AIDS) and in immunosuppressive patients.Ocular involvement is rare and usually is a part of a multicentric disease in AIDS population.

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Bone densitometry. Current aspects about radiological diagnosis of osteoporosis

Hippokratia 2002; 6 (3) 111-117

N. Vougiouklis

Abstract

The diagnosis of osteoporosis is currently based to a great degree on the measurement of the bone density using the technique of dual energy X-ray absorptiometry known as DEXA. By using this technique one can, with satisfactory accuracy, diagnose osteoporosis at an early stage and estimate, under certain circumstances, its development. During life time the bone mass changes at a different rate for each bone. So to make a correct estimation of osteoporosis it is necessary to correlate the findings with other parameters such as the age, weight, race, gender and to take into consideration the examined bone. As the mean life expectancy increases, the incidence of osteoporosis increases too.In this review a brief description of the natural history of osteoporosis and its relation with bone density is made, the indications of bone densitometry are analyzed. Also questioning for the choice of the best method for estimating bone density and the time for the reexamination are discussed. Information for the technique and how bone density is estimated is given.It is made clear why the correct estimation of the results for the diagnosis and the follow up of the disease, presupposes good knowledge of the accuracy and the precision of the method. Finally, the speculation for financial results of the assessment is referred too.

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Vasicoureteral reflux in children:Surgical or nonsurgical management

Hippokratia 2002, 6 (3): 118-122

G. Kasselas, G. Tsikopoulos

Abstract

Since the beginning of the 20th century it has been well known that one of the most common causes of urinary track disease in childhood is Vesicoureteral Reflux (VUR). Normally there is a valvular mechanism which does not permit reflux of urine from bladder to ureters during voiding. The single most important factor in maintaining this one-way characteristic of the ureterovesical function is the occlusion of the ureteral lumen as the increase in intravesical pressure compresses it against the defrusor muscle. If, for any reason (congenital or acquired), this valvular mechanism is disturbed, vesicoureteral reflux becomes apparent. Technological progress and prenatal diagnosis have offered much to the evaluation and treatment of the disease the last years. Today surgical treatment of VUR by means of ureteral reimplantation in the bladder wall is recommended only in severe, persistent cases with recurrent urinary infections and renal scarring despite antibiotic therapy. Having good knowledge of the clinical symptomatology and the consequences in renal function, most children receive proper antibiotic chemoprophylaxis as the treatment of choice. In case that conservative treatment fails to improve the situation we proceed to surgical treatment as a definite treatment. The argument that still exists between pediatric surgeons, pediatricians, pediatric nephrologists and pediatric urologists, concerns the disagreement between conservative and surgical treatment. If we accept as an undoubtful fact that VUR is not a single pathology but a complicated urodynamic phenomenon that in its initial appearance may be a transient stage to disease and destruction of renal parenchyma, then we believe that all of us agree about the pattern of treatment and management of the disease.

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Comparison of the effect of fibrin selective thrombolytic agents on the acute myocardial infarct.First clinical experience

Hippokratia 2002, 6 (3): 123-128

I. Voyiatzis, T. Karamitsos, P Prodromidis, I. Vayianou, S. Papachatzi, E. Kambitsi

Abstract

It is widely accepted that reducing the duration of administrating the fibrin-selective thrombolytics (plasminogen activators) we can improve the thrombolysis and the patency of coronary vessels (TIMI 3) responsible for the myocardial infarction.The aim of the study was to estimate the efficacy and safety of plasminogen activators as thrombolytic therapy in acute myocardial infarction.Seventy patients (54 men - 16 women, aged 58.13 + 10.92 years) with acute myocardial infarction were randomly assigned within 8 hours after the onset of their symptoms to receive reteplase (35 patients, 28 men - 7 women, aged 56.03 + 11.28 years), in 2 bolus doses of 10 U each given 30 min apart, or accelerated alteplase (35 patients, 26 men - 9 women, aged 60.23 + 10.28 years), up to 100 mg infused over a period of 90 min. We studied the epidemiological and clinical characteristics, biochemical markers, the left ventricular systolic function (ejection fraction) and complications. We also estimated the patency of coronary vessel, responsible for the myocardial infarction and mortality rate at 30 days follow up.The mortality rate at 30 days was 5.76% for reteplase and 3.65% for alteplase (p=0.3 / O.R = 1.06). Complications rate was also the same (17.8% - 19.8% / p = 0.18). Ejection fraction was 47.6 + 10.76% and 46.54 + 9.84% (p = 0.5). Patency rate (TIMI 3) was 65.5% and 62.4% (p=0.5). The 2 fibrin-selective thrombolytics are efficacious agents with comparable results in safety, with similar survival results at 30 days in this trial. Reteplase can be given bolus because of its longer half life, so it is proven easier in administration.

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The Clinical and Laboratory Picture of Leptospirosis. Twenty-year experience

Hippokratia 2002, 6 (3): 129-136

E. Koutlas, L. Nikolaidou-Tokalaki, G. Zacharakis

Abstract

Leptospirosis (L) is caused by various serovars of L. interrogans. Its clinical appearance varies from a mild anicteric to a severe icterohemorrhagic (Weil's syndrome). The aim of this retrospective study is to quote our experience as to the clinical appearance of this entity. Eighty eight sporadic L cases served as material (men: 85, women: 3), of mean age 41.7�14.2 yrs, admitted during the last 20-year period (1981-2000). The diagnosis, made mainly on clinical grounds, was confirmed serologically by an ELISA, in 77.4% of the cases. Symptoms, complications, the most characteristic laboratory findings and the course of the illness were analysed. Results. 1. The clinical manifestations, in declining order, were fever: 100%, renal participation: 85% (azotemia: 54.5%), jaundice (bilirubin > 3.0 mg/dl): 80.7%, myalgias: 80%, digestive tract involvement: 48%, hypotension: 38%, headache: 37% (nuchal rigidity: 7%, abnormal CSF: 2.3%), 2nd wave of fever: 24.1%, respiratory system involvement: 23.9%, manifestations from the skin and the eyes, each by: 9.0%. 2. Laboratory findings: Creatine-phosphokinase (CPK) gave characteristically high peak values (717.3±904.5 IU/L), but not alanine-aminotransferase (ALT: 92.8±82.2 IU/L). Blood urea nitrogen (BUN) and creatinine, both gave also abnormal peak values (137.1± 89.3 mg/dl and 3.46±2.7 mg/dl respectively), as did bilirubin (16.9±13.9 mg/dl). There was also a fall in platelet count (100.7±70.6 x 109/L). 3. The course was good in 87.5%. Severe complications appeared in 11 patients (12.5%), of whom 10 (11.4%) died. Mean patient arrival time was 7.2±4.6 days, mean pyrexia duration: 7.8±3.3 days, mean duration of hospitalization: 13.2±7.2 days, and mean duration of illness (in the survivals): 20.4±8.1 days. In conclusion, L lasting approximately 3 weeks, appeared, at least in those who were admitted, as a severe illness, mainly with jaundice, myalgias, and renal involvement, but with lungs, CNS, skin, and eyes being sparsely involved.

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Irradiation injury of the dental pulp after theurapeutic doses of γ-radiation.Experimental study in rats

Hippokratia 2002; 6 (3): 137-141

S. Stefanidis, A. Ginalis, M. Dermenjopoulou, M. Kannelaki-Kyparissi

Abstract

The aim of this experimental study was to evaluate the microscopic alterations in normal dental pulps, associated with therapeutic doses of gamma irradiation. Sixteen adult male Wistar rats were irradiated in the mandibular region with a single dose of 2.000 cGy from a Co-60 source. Groups of two were sacrificed 15, 20, 25, 30, 45, 60, 75, and 90 days after irradiation. Dental pulps from incisor teeth were removed and fixed in formaldehyde solution and sections were stained with Eosine - Hematoxyline and Gomori techniques. The following histological alterations were observed: 1) Edema in the connective tissue of the pulp and around the blood vessels. 2) Progressively established narrowing of pulp vessels' lumen because of thickening of their wall, observed after the 25th day. 3) Obstruction of the lumen in a significant proportion of vessels, after the 75th day. 4) Appearance of newly developed capillaries, mainly at the periphery of the pulp, observed after the 25th day. 5) The amount of the connective tissue cells and reticular fibers of the pulp was obiously increased after the 45th day. 6) Foamy degeneration of the cytoplasm in the outer region of the odontoblasts.

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Postgraduate didactic credits of Continius Medical Education

Hippokratia 2002, 6(3) 144-154

A. Vidalis

Abstract

The present article is attempting a presentation of major recommendations/proposals and applied models of the Continuing Medical Education and Professional Development of recognized expertise medical doctors on Greek territory.In addition, indicative feasible practices of CME/CPD in the state members of the EE are cited. Furthermore, the educational programs and the other different scientific meetings that fulfill the goals of granting credits to participants are indicated. Finally, an extensive report per scientific CME activity considering the number of credits they correspond to is drawn up.

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