Kaposi sarcoma after renal transplantation

Hippokratia, 2004; 8(1):3-6

M Charalampidou, M Krikeli M, E Destouni, G Vergoulas
Radiotherapy Dpt, General Hospital "Theagenio", Theesaloniki, Greece
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

The immunosuppressive regimen of patients with renal transplantation increases the danger of appearance of Kaposi sarcoma significantly. The early diagnosis and prompt treatment may result in kaposi's disappearance with preservation of graft function. We present the characteristics of sixteen patients who developed Kaposi sarcoma after renal transplantation, their treatment and the results.

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Gynaecomastia

Hippokratia 2004; 8(1):11-18

M Somali, M. Kontopoulos
Endocrinology Dpt, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

Gynaecomastia is the most frequent benign condition of the male breast with a frequency 40% to 66% in adults and 30% to 66% in adolescents. The histologic features of gynaecomastia consist of benign enlargement and proliferation of the mammary gland constituents. Clinically it is described as a bilateral, palpable discoid enlargement of the breast tissue beneath the areola, usually tender and symmetrical. Physiological enlargement of the male breast is seen in newborns, during adolescence and in healthy elderly men. In pathologic states gynaecomastia can be caused by a deficiency of testosterone formation or action, enhanced estrogen production or drugs. In idiopathic gynaecomastia no underlying endocrinopathy is revealed. A careful physical examination supported by an endocrine work-up and the use of imaging techniques usually reveals the cause and rule out the possibility of estrogen producing neoplasms. Mammography and fine needle aspiration biopsy are considered in cases where breast cancer is suspected. Androgens (dihydrotestosterone and danazol), antiandrogens (tamoxifen and clomiphene) and reductase inhibitors (anastrozole and letrozole) have been used in the treatment of pathologic gynaecomastia of recent onset with ambiguous results. Corrective surgery offers treatment where pharmacologic manipulation has failed, in long standing gynaecomastia for aesthetic reasons and in suspected breast cancer.

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Iron metabolism and laboratory investigation of iron deficiency anemia

Hippokratia 2004; 8(1):19-25

T.M Alemayehu
BTC, Hippokratio General Hospital, Thessaloniki, Grreece

Abstract

Iron deficiency anemia is the most common nutritional deficiency anaemia affecting millions of people world-wide. The main effects of disturbances in iron metabolism, i.e. iron deficiency and iron overload, have specific consequences on the health of the individual, and should be investigated and treated promptly and appropriately.
Most of the laboratory tests used to identify patients with iron deficiency or iron deficiency anemia are simple and can be carried out in most hospital laboratories. The results nevertheless, should be interpreted with caution because different parameters can affect the test results. One should decide which laboratory tests are to be used depending on the cost effectiveness, specificity and simplicity of the method.
Recently, non-invasive methods are also used to determine the level of iron overload in the liver and heart of patients with hereditary hemochromatosis and other hematologic diseases accompanied with hemosiderosis. Magnetic resonance imaging of the liver is much more easily accepted by the patient than liver biopsy and the results are satisfactory.

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The familial occurence of classic type Kaposi sarcoma

Hippokratia 2004; 8(1):26-28

M Charalampidou, M Krikeli, E Destouni, G. Vergoulas
Radiotherapy Dpt, Theagenio General Hospital, Thessaloniki, Greece
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

The Familial occurrence of classic type Kaposi sarcoma is extremely rare and very few cases have been reported in the world literature. We present the clinical picture of two couples of patients with Familial Kaposi sarcoma who were members of the same family respectively.

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Choledochal cyst in an adult

Hippokratia 2004; 8(1):29-34

T Gerasimidis, A Ntinas, D Tsantilas, G Fragandreas, C Spiridis, G Imvrios, E Akriviadis, E Zafiriadou, K. Patsiaoura
5th Surgical Dpt, Hippokratio General Hospital, Thessaloniki
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki,
4th Internal Medicine Clinic, Hippokratio General Hospital, Thessaloniki
1st Radiology Dpt, Hippokratio General Hospital, Thessaloniki
Pathology Dpt, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

Choledochal cyst in adults is a rare condition. The authors report on a case of choledochal cyst, with emphasis on the diagnosis and management. The clinical symptoms are sometimes subtle, but is also reported the complete classic triads symptoms: abdominal pain, jaundice and palpable abdominal mass. We present here a case of a 19-year-old man with abdominal pain of intermittent character and vomiting. The symptoms appeared 18 months prior to admission, with progressive aggravation. CT scan, ultrasound, MRI and MRCP contribuited significantly, but the diagnosis was established by ERCP. It was a type Ib choledochal cyst according to the classification system proposed by Alonzo-Lej. Total excision of cyst with Roux-en-Y hepaticojejunostomy and cholecystectomy was performed. The young man until now is completely asymptomatic.

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Long-term patient follow-up because of oral anticoagulation

Hippokratia 2004; 8(1):35-39

IA Voyiatzis, E Kambitsi, T Karamitsos, M Kachrimanidou, IM Vogiatzis
Cardiology Dpt, General Hospital of Veria, Veria, Greece
Haematology Dpt, General Hospital of Veria, Veria, Greece

Abstract

Introduction: The management of oral anticoagulation is fraught with difficulties. The aim of the study was the evaluation of the ability, safety and efficacy of patients to self- monitor and self-adjust the dose of their oral anticoagulants.
Methods: We studied 12 patients (5 men - 7 women, 59.9?� 11.99 years) with guides to self-monitor the Prothrombin Time (PT) at hospital Laboratory and self - adjust the dose of their anticoagulant (Group A) compared with 15 control patients (7 men - 8 women, 51.9?�5.06 years) followed the classic methods of follow up (Group B).
Results: Group A patients monitored their PTs significantly lesser times than Group B patients (8.17?�3.83 / 15.7?�4.83 per patient, p: 0.02) with fewer dosage changes than control patients (4.91?�1.05 / 8.46?�1.50, p < 0.05). The PTs in group A patients were in recommended therapeutic range in 82.3 % of the determinations compared with 65.7 % in group B patients (p < 0.001). Group A patients made 3.1 % incorrect dosage changes and group B 3.9 % (p: 0.1). There were no significant differences in complications between the patients of the two groups.
Conclusion: Patients can successfully measure their PT, adjust their anticoagulant dosage (like diabetics their insulin dosage) and achieve an acceptable therapeutic effectiveness.

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The lack of insurance of elderly patients and the impact on their health and functional capacity

Hippokratia 2004; 8(1):40-43

IA Vogiatzis, A Kotsani, T Karamitsos, E Kambitsi, IM. Vogiatzis
Cardilogy Dpt, General Hospital of Veria, Veria, Greece
Otolaryngology Dpt, General Hospital of Veria, Veria, Greece

Abstract

Background: A relatively large proportion of the elderly population receives inadequate health care, mainly due to lack of Health Insurance, since this seems to be a rising social problem over the last years.
The aim of this study is to evaluate the overall functional and health state of hospitalized elderly patients without Health Insurance.
Subjects and Methods: A total of 136 old-aged patients presenting with common health problems were enrolled in the study. In-hospital care costs were borne by an insurance company in 68 of them, (Group B, 38 males- 30 females, mean age 73.6?�8.5 years), whereas the rest 68 patients lacked any form of Health Insurance (Group A, 40 males - 28 females, mean age 72.5?�5.32 years). Clinical and epidemiological data of both groups were analyzed, focusing on functional state, wellbeing and mortality on admission, 6 months and 1 year after discharge, by which time 40 patients of the 1st group (Group A) were already enrolled in a Public Health Insurance Program (Group C , 28 males - 12 females, mean age 71.4 ? 4.5 years).
Results: Elderly patients without Health Insurance were functionally impaired and in a worse state of health compared to those with any form of Health Insurance (21.6 % vs 12.8 %, p: 0.02). During the follow-up period, patients with recently acquired Health Insurance presented with a better quality of life, (12.8 %, p: 0.04), but still remained at a lower level when compared to those of Group B (Group A: 48.7 % - Group C: 22.5 % vs Group B: 10.7 %, p: 0.01). Mortality rates were significantly lower in Group B, as well (Group A: 13.4 % - Group C: 8.3 % vs Group B: 2.8 %, p < 0.001).
Conclusion: Poor functional state, bad health and higher rates of mortality in the elderly are closely related to the lack of Social and Health Insurance.

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Research aprroaches in medicine: I. Cohort trials, case-control studies and randomised control trials

Hippokratia 2004; 8(1):44-48

DG Goulis, GV Vergoulas
Endocrinology Dpt, Hippokratio General Hospital, Thessaloniki, Greece
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

The two main groups of research methods are observation studies and intervention studies. In this review two examples of observation studies are discussed: cohort studies and case - control studies, as well as an example of intervention studies: randomized controlled trials.
In cohort studies, the researchers recruit subjects without the disease under investigation, who are exposed to risk factors for this specific disease. The subjects are followed-up prospectively and the diseases that emerge are recorded systematically. The results are analyzed at the end of the study. The main difference between cohort studies and case - control studies is that in the later the disease under investigation has already been diagnosed. The researchers recruit a patient and a control group, indicate the incidence of risk factors in the two groups and compare the ratios. In randomized controlled trials, the subjects are randomized into intervention and control groups. Ideally, neither researchers nor patients must know if the patients have randomized into the intervention or the control group. Finally, a comparison between the two groups takes place in order to search for statistically significant differences.
The three types of studies mentioned in this review are commonly used in medical research. Medical personnel who are interested in research should learn these methods thoroughly. Those doctors who are not involved in medical research should familiarize themselves with the inherent strengths and weaknesses of different research study designs so that they can be more critical when appraising published articles.

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Treatment of Paget's disease with administration of zoledronic acid

Hippokratia 2004; 8(1):7-10

N Krikis, K Tziomalos, G Sfikas, A Karagiannis, V Perifanis, V Georgopoulou, A Papanikolaou, F Harsoulis
2nd Propedeutic Dpt of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Grrece
1st Radiology Dpt, Hippokratio General Hospital, Thessalonki, Greece

Abstract

A case of an asymptomatic patient with Paget's disease who was treated with zoledronic acid is reported. The diagnosis was based on radiological findings, histology and elevated alkaline phosphatase. The elevated alkaline phosphatase was decreased and remained within normal range for fifteen months, following a single intravenous administration of 4mg zoledronic acid, whereas the radiologic findings remained unchanged. The role of biphosphonates in Paget's disease is reviewed and the comparative advantages of zoledronic acid are pointed out.

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