Antiatheromatic action of exercise

Hippokratia 2003; 7(1):3-11

G.H Antonakoudis, H.G Antonakoudis
Asklipiion Hospital Vulas, Athens, Greece

Abstract

Sedentary life is a very important coronary risk factor while there is no doubt that dislipoproteinemia consists the most important factor. Physical activity and exercise training not only improves physical performance but also improves endothelial function and modiles almost all coronary risk factors. Especially it improves all three components of atherogenic lipid profile as LDL (especially the most atherogenic LDL 6 subfraction) decreases, triglyceride decreases and HDL increases, especially the most atherogenic subfraction HDL 2 . The mechanisms leading to these exercise induced lipid changes have been proved and well documented by muscle biopsies and their description is the main target of this article.Working muscle plays a central role on the control of lipid metabolism.Increased physical activity induces a number of positive changes on lipid metabo-lism. The exercise induced increased activity of lecithino -cholestero - acyltransfase and lipoproteine lipase and decreased activity of hepatic lipase lead to LDL reduction,tryglicerides ’reduction and HDL increase.All these enzymatic changes have been documented by muscle biopsies. Exercise induced lipid changes are much more prominent in the era of primary prevention and especially in, so called, primordial prevention which means the prevention of risk factor development.In the era of secondary prevention, where the target of lipid levels are much more lower, the contribution of exercise is also signilcant but aggressive drug therapy must be suggested in parallel to exercise and diet. Recently significant importance is given to direct antiatheromatic ef fect of exercise,as significant benelcial ef fect on endothelial function has been proved, both in animal and human studies. According to recent guidelines on Cardiac Rehabilitation multifactorial intervention (exercise, diet, education, counseling with or without lipid lowering drug therapy) result in asignificant improvement in blood lipid levels and are strongly recommended as components of cardiac rehabilitation. On the other hand, cardiac rehabilitation exercise training is not recommended as a sole intervention for lipid modification. Optimal lipid management requires specifically directed dietary and a medically indicated pharmacological management in addition to exercise training.

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General anesthesia in morbidly obese patients. Some late considerations

Hippokratia 2003;7(1):12-21

K Spanopoulos
1st Anesthesiology Dpt, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

Obesity is the condition of excessive body fat which results to severe respiratory and cardiovascular complications.General anesthesia compounds signif icantly impair most of these problems so preoperative assessment should be very careful and detailed.Induction of anesthesia is likely to be a particularly hazardous time for these patients with an increased risk of difficult or failed intubation.Anesthesia add signif icantly to the derangement of gas exchange and lung volumes.Postoperative ventilation is more likely to be required in these patient and after surgery they should be recovered in the intensive care unit.Morbid obesity is also associated with cardiovascular problems such as ischemic heart disease,hypertension,cardiac failure,arrhythmias and thromboembolic disease. Given the high probability of underling cardiorespiratory impairment, obese patients should be considered as high risk patients in both surgery room and the intensive care unit.

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Anesthetic management and administration of atropine during angioplasty of stenosis of the internal carotid

Hippokratia 2003; 7 (1):22-26

V Sdrani, D Karamanos, H Pezikoglou, A Fileli, K Papazoglou, A Kamparoudis, Th Gerasimidis
5th Surgical Dpt, Hippokratio General Hospital. Thessaloniki, Greece

Abstract

Twenty one patients were studied with an average age of 71.2 years who underwent angioplasty and stenting due to stenosis of the internal carotid. Aim of this study was to assess a) the administration of atropine for the management of bradycardia and b) the haemodynamic fluctuations of the patients. The latter were divided randomly into the control group and the group where atropine was administered preventively.
Our results showed that all patients presented significant bradycardia and hypotension, 21.4 % of patients of the control group presented serious bradycardia, while only the 11.5 % of the atropine group respectively (p < 0.05). Three patients (17.5 %) developed significant tachycardia immediately after preventive administration of atropine (p < 0.05).
Conclusively, the preventive administration of atropine during angioplasty of the internal carotid prevents the onset of dangerous bradycardia, but does not avoid the presence of undesired, for these patients, tachycardia.

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The red blood cell deformability in patients suffering from end stage renal failure on haemodialysis or continous ambulatory peritoneal dialysis

Hippokratia 2003; 7 (1):27-32

N Sotirakopoulos, T Tsitsios, M Stambolidou, G Athanasiou, V Kokkinou, K Mavromatidis
Dialysis Unit, General Hospital of Komotini, Komotini, Greece, Laboratory of Dioengeniaring, University of Patras, Patras, Greece

Abstract

Anemia is the main problem for patients suf fering from end stage renal failure (ESRF).In this study the index of rigidity (IR), that shows red blood cells (RBCs) deformability was determined, in patients with ESRF that were on maintenance haemodialysis (HD) or on peritoneal dialysis, in order to find out if there are disturbances that can explain the cause of anaemia.
The IR was determined in 39 haemodialysed patients, that were dialysed from 16 to 120 months (M?�SD: 41.8?�24.1) and constituted group A.Furthermore,this index was studied in 32 patients on continuous ambulatory peritoneal dialysis (CAPD), that were dialysed from 6 to 60 months (M?�SD: 10.7?�9.9 and constituted group B. Finally, the index was studied in 17 normal individuals that constituted the control group (group C). The IR of RBCs was determined in group A twice (before and after the end of a haemodialysis session) and in the other two groups (B,C) once. All patients (HD and CAPD) were in substitution treatment for more than 6 months. The IR was determined haemoreometric (method of f iltration), with special equipment. According to this method the deformability of the RBCs was determined. That is,the more deformability of RBCs increasing,the less starked they are. In group A an increased IR was observed in comparison to the control group (C) (17.9?±6.2 vs 10.2?±1.8, p < 0.0001), that increased more after the end of the haemodialysis session (paired t test, p < 0,0001). The IR of RBCs in CAPD patients was signif icantly lower than this of HD patients (12?±3.8 vs 17.9?�6.2, p < 0.0001) and it was not statistically different from the control group (12?±3.8 vs 10.2?±1.8, p: 0.068).
It can be concluded from the study that: a) In HD patients there are disturbances of deformability of the RBCs, that are worsened with haemodialysis session b) the index of rigidity of RBCs is signif icantly higher in the HD patients in comparison to CAPD patients c) in patients on CAPD the disturbance of deformability of the RBCs was less in comparison to the control group, which however does not reach the statistically signif icant levels.

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Reduction of the opioid needs after administration of lornoxicam for the relief of postoperative pain in orhtopedic patients

Hippokratia 2003,7 (1):33-36

Z Kanonidou, P Tsaousidis, D Iordanidou, D Atmatzidis, G Vergoulas, F Aidoni
3rd Anesthesiology Dpt, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

We studied 50 patients who underwent a median severity orthopedic surgery of lower extremities with spinal anesthesia. Twenty f ive patients of the group A received as postoperative analgesia meperidine combined with a nonsteroidal antilammatory drug (NSAID), Lornoxicam, in a dose of 8 mg i.v., while the rest twenty five patients of the group B received meperidine alone. We recorded the opioid needs, assessing the pain intensity every 6 hours using the Visual Analogue Scale of pain (VAS).
The meperidine dose combined and not with Lornoxicam was: 0.72?�0.07 /1.02?�0.06 mg / kg, 0.69?�0.08 / 0.97?�0.07 mg / kg, 0.62?�0.08 / 0.87?�0.09 mg / kg, 0.54?�0.08 / 0.74?�0.11 mg / kg, 0.53?�0.08 / 0.64?�0.08 mg / kg, in 0, 6, 12, 18 and 24 hours respectively (p: 0.0005). We found that the patients of the combined opioids-NSAIDs group consumed a lower opioid dose related to the patients who received only opioids. The postoperative pain more efficiently by decreasing the opioid side-effects.

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Topical surgical wound infiltration with ropivacaine for postoperative analgesia in paediatric patients

Hippokratia 2003; 7(1):37-40

Ch Bratzou, A Efthimiou, D Iordanidou, M Milona, P Pappas, M Ventouri
3rd Anaesthesiology Dpt, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

The newer local anaesthetic agent ropivacaine has been extensively studied in adults as an agent of postoperative analgesia by means of surgical wound inf iltration. In our study we tried to evaluate the eficacy and safety of this agent for the same purpose in paediatric patients. 42 paediatric patients,1-8 years old,who underwent a minor procedure under general anesthesia, were included in the study.The surgical wound was inf iltrated with ropivacaine 0.5%up to 3 mg /kg B.W. Postoperatively and for 6 hours, wound pain and side effects were recorded. Thirty five patients (83.3%) did not need further postoperative analgesia. Three patients (7.1%) had episodes of postoperative nausea - vomiting, while intra-or postoperative complications by ropivacaine did not occur. Surgical wound infiltration with ropivacaine is a simple, effective and safe method of postoperative analgesia in the paediatric patient.

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Iron deficiency anaemia in 12-24 months old children in Thessalia, Greece

Hippokratia 2003; 7(1):41-48

E Tympa-Psirropoulou, C Vagenas, O Dafni, S Karagiannopoulou, A Matala, D Psirropoulos, F Skopouli
Charakopio University of Athens, 2nd Dpt Internal Medicine, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

Iron delciency anemia (IDA) is a common problem all over the world, which more often attacks pregnant women, infants and children. The aim of the study was to estimate the prevalence of IDA in children 12-24 months old in the area of Thessalia located in the central part of Greece. In the 1st part of this cross-sectional and case-control study, the haemoglobin (Hb) levels of 938 children (approximately
the one third of the total children population) were estimated by a mobile photometer analyzer. This method is not in common use in Greece. Hb values below 11 gr / dl of blood have been defined as one of the diagnostic limits of IDA. In the second part children with Hb < 11 gr / dl were compared with their random selected controls (matched one by one in sex,age and locality) in hematological and anthropometric parameters (weight, height, head circumference, weight scale and height scale). The estimated laboratory values were Hb, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, zinc protoporphyrin, serum iron, serum ferritin, transferring saturation, total iron binding capacity and Hb electrophoresis. Finally 75 children (34 boys, 41 girls, mean age 17.51?±3.5 months), who were found with IDA, constituted the case group whilst 75 healthy children constituted the control group. The statistical analysis was performed using the SPSS version 10.
The prevalence of IDA in the region was 7.99%. At the same time, a number of children with stigma of b-thalassaemia (2.13%) was discovered, which was previously ignored. The values of Hb, mobile and laboratory were without difference between the two groups whereas significant difference was recorded (p < 0.001) in all hematological and anthropometrical parameters except head circumference. Although the prevalence of IDA in this area of Greece is approximately similar to others in the developed world, it still consists a public health problem. The mobile method for Hb estimation should also be used widely in Greece since its reliability to detect IDA has been conlrmed in this study too. The further improvement of the present IDA status in Greece could be achieved through the continuous information about iron rich foods and its absorption, the melioration of environmental conditions and the application of reliable,easy to use and cheap methods for Hb estimation.

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