New progress in the management of hepatocellular carcinoma

Hippokratia 2004; 8(3):99-106

G. Imvrios
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

Hepatocellular carcinoma (HCC) represents more than 5% of all cancers worldwide. The management of HCC begins with diagnostic confirmation by radiologic imaging or histology. Currently, the prognosis and choice of treatment are largely based on the crude parameters staging,- extent of tumor growth and the presence of vascular invasion-, and the functional state of the liver. Surgery in the form of either hepatic resection or orthotopic liver transplantation, is the only potentially curative treatment and in carefully selected patients with HCC, good results can be obtained from both methods. Transarterial chemoembolization is commonly used as either palliative treatment or adjunctive therapy to surgery. Local ablative therapy may have curative potential in those patients with sufficiently small lesions and adequate liver function. Systemic chemotherapy has low efficacy and significant complication rate. An increasing number of patients with small HCC and decompensating cirrhosis have a benefit from the clinical application of adult-to-adult living donor liver transplantation. Molecular profiling and genetic analyses of HCC to determine the biologic behavior of the tumor, perhaps is the future prospects for the choice of treatment with more consistent results.

Read PDF

Read more...

Our knowledge on Severe Acute Respiratory Syndrome (SARS)

Hippokratia 2004; 8(3):107-111

G. Ilonidis
4th Medical Dpt, Aristotle University of Thessaloniki, Thessaloniki, Greece

Abstract

The atypical pneumonia, named by WHO Severe Acute Respiratory Syndrome (SARS) is discussed in detail. After the appearance of SARS and its rapid spread, there was a world -wide medical reaction, which in a very short period of time resulted in the isolation of the causative agent which appeared to be a corona -virus.
Virus transmission is quite easy through the respiratory droplets, that are released when an infected person coughs or sneezes, as well as by the direct contact with infected person's body fluids. High fever, shivering, cough, general malaise, dyspnoea and severe hypoxaemia are the basic symptoms of the disease.
Diagnosis of SARS is based on the haematological, biochemical and immunological findings. The pulmonary infiltrations are common in chest X-ray. The sign of ground glass picture is common in pulmonary Computerized Tomography (CT). Taking of preventive measures in combination to the patient isolation are the most effective measures for facing the disease. The use of antivirus drugs has shown ambiguous effectiveness. The antibiotics are administered only when the possibility of microbial superinfection is evident.

Read PDF

Read more...

Postpartum Thyroiditis

Hippokratia 2004; 8(3):112-120

M Kita, A Saratzis
Endocrinology Dpt, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

Postpartum thyroiditis is a syndrome of transient or permanent thyroid dysfunction occuring in the first year after delivery and is based on an autoimmune inflammation of the thyroid. The prevalence ranges from 1,1-21,1%. The role of antibodies (especially thyroid perodixase antibodies), complement, activated T cells, and apoptosis is important in the outbreak of postpartum thyroiditis. Postpartum thyroiditis is conceptualized as an acute phase of autoimmune thyroid destruction in the context of an existing and ongoing process of thyroid autosensitization. From pregnancy an enhanced state of immune tolerance ensues. A rebound reaction to this pregnancy-associated immune suppression after delivery explains the aggravation of autoimmune syndromes in the puerperal period, e.g., the occurence of clinically overt postpartum thyroiditis. Low thyroid reserve due to autoimmune thyroiditis is increasingly recognized as a serious health problem. 1) Thyroid autoimmunity increases the probability of spontaneous fetal loss. 2) Thyroid failure due to autoimmune thyroiditis, often mild and subclinical, can lead to permanent and significant impairment in neuropsychological performance of the offspring. 3) Evidence is emerging that as women age subclinical hypothyroidism-as a sequel of postpartum thyroiditis-predisposes them to cardiovascular disease. Hence, postpartum thyroiditis is no longer considered a mild and transient disorder. Screening is considered every six months.

Read PDF

Read more...

The determination of anti-X efficacy of Tinzaparin in the anticoagulant regulation of haemodialysis

Hippokratia 2004; 8(3):121-123

G Kyriakopoulos, B Lampiri, I Kyriakopoulou, E. Mavropoulou
Nephrology Dpt, General Hospital of Latissa, Larissa, Greece
Haematology Dpt, General Hospital of Larissa, Larissa, Greece

Abstract

Background: The low molecular weight heparin (LMWH) Tinzaparin (T) is used as an anticoagulant in haemodialysis. For the achievement of the proper anticoaggulant it is required the quantitative determination of T levels and is expressed as anti-X efficacy. The aim of this study is to check the effectiveness of T as a bolus dose prior to haemodialysis.
Patients and Methods: A total of 54 patients have been examined and divided into 2 groups according to their weight. The 1st group (45 patients) received 3500 I.U. of T and the 2nd group (9 patients) 4500 I.U. of T. Those patients with body weight (BW) over 70 kg received 4500 I.U. At the beginning and at the end of the third hour, blood has been taken for the quantitative determination of the anti-X efficacy, fibrinogen, prothrombin time (PT) and partial thromboplastin time (?�?T). The results have been correlated with I.U. of T per kg b.w and between them. The anti-X efficacy in plasma has been analysed at 405 nm using chromatometry (STAGO, Rotachrom HBPM / LMWH).
Results: The anti-X efficacy at the third hour fluctuated for the first group between 0.12- 0.82 I.U. / ml with mean value 0.52?0.17 I.U. / ml and for the second group between 0.30-0.97 I.U. / ml with mean value 0,53+0,21 I.U. / ml. Low values (0.07 and 0.12 I.U. / ml) have been found in two patients of the first group. After the increase of the providing dose of T to 4500 I.U., the anti-X efficacy has been increased to 0.32 I.U. / ml and to 0.36 I.U. / ml respectively. The dose in I.U. T per kg BW fluctuated in the 1st group between 36.45- 92.10 with mean value 57.97? 14.34 and in the 2nd group between 52.32- 95.74 with mean value 68.97? 14.75. In most of the patients a prolongation of the ?�?T has been found. It has been observed that there was no correlation between fibrinogen, PT, ?�?T and I.U. T per kg BW However, in the total of the patients (1st and 2nd group), a small but statistically significant correlation (r = 0.61, p<0.05) was found between I.U. T per kg BW and the values (I.U. / ml) of anti-X efficacy.
Conclusions: The initial bolus dose of T is satisfactory and with a mean value of 60 I.U. of T per kg BW achieved a mean anti-X efficacy of 0.52 I.U. /ml which is adequate in order to have suitable anticoagulant effects without unnecessary side-effects.

Read PDF

Read more...

Quality of life, psychosocial adjustment and depression in dialysis patients and their spouses

Hippokratia 2004; 8(3):124-127

A Biris, I Kyriakopoulou, E Mavropoulou, G. Kyriakopoulos
Dialysis Unit & Division of Pychosocial Support, General Hospital of Larissa, Larissa, Greece

Abstract
Background: It is known that the quality of life of patients with chronic renal failure changes after the induction in a dialysis programme. The aim of this study was to investigate the quality of life in chronic dialysis patients and the relations with their partners.
Patients and Methods: A specialised inventory including questions on family relationships, work, sexual relationships, use of free time, use of psychotropic medication, and various changes in the way of life in general, as well as demographical data has been used. A similar inventory was also completed by spouses. In addition participants and their spouses completed Beck's Depression Inventory (BDI). The sample consisted of 37 patients and 20 spouses, 57 adult individuals in total. In some of the patients and their spouses who have completed at least three years of study in high school, personality tests have been employed using the Minnesota Multiphasic Personality Inventory -MMPI (n = 28) and at the same time clinical interviews have taken place.
Results: The results indicated high depression rates and positive correlation in BDI scores between subjects and their spouses. An increased amount of free time was observed in the patient being spent doing hobbies, traveling, and with friends. It was further observed that the time spent with family members as well as watching television was significantly decreased. Emphasis was also provided by subjects regarding the quality of medical expertise, and the need for improved human contact. Conclusion: Patients starting chronic hemodialysis program and their partners present depression symptoms in a very high rate. There is a negative coorelation between depression and educational status or their income. They need psychologic support to become productive again.

Read PDF

Read more...

The antioxidant action of statins and other antioxidants in dyslipidaemia

Hippokratia 2004; 8(3):128-132

A Tzanakari, I Efthimiadis, A Tavridou, Ap Efthimiadis, D Psirropoulos, N Lefkos
Division of Prevention of Athrosclerosis Risk Factors, 2nd Dpt Medicine, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

Introduction: The influence of statins and antioxidants administration on patients with familial dyslipidaemia (phenotypes IIa and IIb) was the aim of the study.
Methods: Forty-four patients (pts) (M=34, F=10, mean age 48?7.2 years) with dyslipidaemia were divided randomly in two groups. Simvastatin (40mg daily) was administered as monotherapy in Group A (M=18, F=4) and vitamin E was administered also as monotherapy (150mg daily) in Group B (M=16, F=6). The levels of hemoglobin, hematocrit, glucose, cholesterol (total, LDL, HDL), triglycerides, cardiac enzymes (SGOT, SGPT, CPK) and free oxygen radicals (FOR) were estimated at baseline and four months later. Pts with coronary artery disease, arterial hypertension, diabetes mellitus and severe valvular disease were excluded from the study. The statistical analysis was performed using the statistical software package SPSS v 10.
Results: In Group A the FOR levels were decreased significantly (285.81? 20.4 U Carr - 240.69 ?18.74 U Carr, p< 0.001) and the lipidaemic profile was also improved significantly. In Group B there was not any significant alteration in the estimated values.
Conclusion: In pts with familial dyslipidaemia the statins expect their favorable effect on lipidaemic profile have overt antioxidant action.

Read PDF

Read more...

Heavy infections causing pneumonia in patients with kidney transplantation

Hippokratia 2004; 8(3):133-142

G. Vergoulas
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

Infectious complications are still one of the major causes of morbidity and mortality after kidney transplantation. In spite the fact that pneumonia in kidney transplants presents the lowest frequency among the solid organ transplants (8% - 16%), it is a threatening infection that frequently nessecitates admittion to the Intensive Care Unit and leads to death in 50% of cases. The diagnosis is frequently difficult because of the large number of pathogens that can cause it, the non-specific nature of clinical and laboratory findings and the failure of sputum and blood specimen cultures to isolate the pathogenic microorganism. Infections due to legionella, nocardia, pneumonocystis carinii, mycobacterum tuberculosis, CMV, aspergillus and candida can cause heavy pneumonia and death in patients with kidney transplantation

Read PDF

Read more...

Current Issue 20 (3)