Halitosis - aetiology, diagnosis, treatment

Hippokratia 2005; 9(1):3-6

K Karnoutsos, E Blioumi
Dental Dpt, "Saint Pavlos" General Hospital, Thessaloniki, Greece

Abstract

Diagnosis and treatment of bad breath is a matter that concerns a large portion of the general population and dentists. Malodorous volatile materials produced by some bacteria on the dorsal surface of the tongue are the main cause of bad breath. These are mainly volatile sulfur components, especially methyl mercaptan and hydrogen sulfide, but also short-chain fatty acids and polyamines. It appears that the gram negative anaerobic microflora is responsible for odor formation .through a two-phase metabolic process (hydrolysis and degradation of amino acids). Metabolic processes which result in pH decrease, O 2 decrease or oxidation reduction potential (Eh) increase favor the growth of gram negative anaerobes and the generation of malodor too. The three main methods of analyzing oral malodor are organoleptic measurement, gas chromatography and sulphide monitoring. A thorough medical and dental history helps the dentist to find the origin of halitosis and classify halitosis into three different categories, that is genuine halitosis (physiologic and pathologic), pseudo -halitosis and halitophobia. Furthermore, a thorough extraoral and intraoral examination may eliminate from consideration some other extraoral and intraoral causes of bad breath . The treatment of malodor consists of mechanical and chemical reduction of microbial flora. The most common ways of treatment are cleaning the tongue with a dentalcleaner or a dentalscraper, use of mouthwashes containing zinc, chlorexidine and hydrogen peroxide and periodontal treatment. Patients with pseudo-halitosis and hatitophobia need to be counseled and assisted by a psychological specialist. In conclusion, since malodor is a common condition in general population, all dentists ought to be informed the causes, diagnosis and treatment of halitosis.

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Quality of life in patients suffering from prostate adenocarcinoma. A global approach

Hippokratia 2005; 9(1):7-16

K Charalabopoulos, Ch Golias, A Charalabopoulos, X Giannakopoulos, A Batistatou
Physiology Dpt, Clinical Unit, Medical Faculty, University of Ioannina, Ioannina, Greece
Dpt of Surgery, Peterborough & Stamford Hospitals, Cambridgeshire, UK,
Dpt of Urology, Medical Faculty, University of Ioannina, Ioannina, Greece
Dpt of Pathology, Medical Faculty, University of Ioannina, Ioannina, Greece

Abstract

Prostate cancer is a major health concern for Western men patients who are facing important decisions, alongside with the physicians, concerning their treatment. Additionally the physician has to take into account the potential side effects of the disease and the treatment itself. Treatment for advanced prostate cancer produces problematic physical and psychosocial side effects having subsequently a significant impact upon the patients’ quality of life (QoL). The patient should be asked by the physician for information concerning daily life activities, overall satisfaction voiding ability and sexual activity in a standardized questionnaire assessing the QoL of the patient. The EORTC-GU has conducted multicenter, multinational and intercontinental trials, disseminating their results via workshops, congresses and symposia. Other questionnaires such as the SF-36, McGill and others assess the QoL of a patient sufficiently responding in parallel to the changing needs of a specific population, taking into account characteristics including poor performance status, difficulty with longitudinal study, rapidly deteriorating physical condition. Generally speaking many such questionnaires and studies have been evaluated or are still in progress regarding cancer patients and even less specifically for advanced prostate cancer. Modern QoL questionnaires are considered to be more than a necessity nowadays for the improvement of the treatment administered from the physician and the performance and functional status of the patient.

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Evidence based medicine

Hippokratia 2005; 9(1): 17-25

G Anogianakis, G Ilonidis
Physiology Dpt, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

Abstract

Evidence based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values, for the best possible patient management. It is the explicit and judicious use of current best evidence in makin decisions about the treatment and care of individual patients. In practice, it means integrating the individual clinical skills of the doctor with the best available clinical evidence from systematic research. EBM is a “patient -centred” rather than “physician - centred” brand of medicine. It deals with clinical problems and questions that arise in the course of caring for individual patients. The practice of EBM is always triggered by a patient encounter which generates questions about the effects of therapy, the utility of diagnostic tests, the prognosis of disease or the etiology of a disorder. It always proceeds in five concrete steps that start from the construction of a clinical question; through the conduct the tracking down of the best evidence of outcomes that is presently available; onto the critical appraisal of the existing evidence and its application to the patient, ending with the physicians’ self-evaluation of their performance.

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Management of patients with transection injury of the spinal cord

Hippokratia 2005; 9(1):26-34

R Gbandi, Z Kanonidou
3rd Dpt Anesthesiology, Hippokratio General Hospital Thessaloniki, Thessaloniki, Greece

Abstract

The pathophysiology of spinal cord trauma and particularly, of the cervical and upper thoracic spinal segment, is often associated with immediate threat to live and with very serious temporal and permanent changes in the function of the whole organism of the trauma victims. As a result, the patients require special anesthetic and intensive care management. By conscious and cooperative patients, a quick neurological evaluation of the sensory and motor reflexes provides immediate information necessary to identify a partial or a complete transection injury of the spinal cord. Associate injuries (e.g. fracture or hemorrhage) are observed in about 10% of the cases and most frequently involve the cervical spinal segment. In unconscious patients or in patients whose level of consciousness is impaired, the cervical spine must be immobilized to prevent a potential neural damage, until spinal cord injury is excluded. In acute situation, the intensive care of such patients may extend from few weeks to many months.

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Update on contraception

Hippokratia 2005; 9(1):35-40

A Papanikolaou, G Makedos
4th Dpt Obstetrics & Gynaecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

Abstract

Contraception is an important health issue in preventive medicine because it protects women globally from the effects of unwanted pregnancy and allows them to integrate in the society. Uncontrolled childbearing in underdeveloped countries carries a significant risk of maternal death. Available methods are not ideal and are a result of a compromise between efficacy and safety. In assessing risks, the consequences of inadvertent pregnancy should no contraception is used must be taken into consideration. Natural methods have a failure rate of 6-25 %. Condom demands motivation but protects from sexual transmitted diseases and can be used in combination with the pill or alone with a failure rate of 12% (3-15%). Barrier methods have failure rates up to 25%. Hormonal contraception is the most efficacious (above 99%) but questions of safety and minor side effects (nausea, headaches, break through bleeding) result in discontinuation rates of at least 30%. The combined contraceptive pill has been scrutinized and found safe and practical for women under 35 with no significant cardiovascular risk. Thrombosis is slightly increased , with an absolute risk of 1-10 more cases in 100,000 women. Increased age, obesity, smoking and hypertension alone or in combination increase the risks significantly and are the main contraindications for its use. Breast and cervical cancer risks are slightly increased but the absolute risks are small, occur after 5 years of use and are reversible. Other hormonal methods with injectable and implantable progestins are safe and practical but not readily reversible and produce menstrual irregularities and sometimes amenorrhea. Hormonal methods have several benefits on reproductive problems such as dysmenorrhea, menorrhagia and ovarian cysts. Intrauterine contraceptive devices (IUCD) are safe and effective with a failure rate of 0,1-1,5% but demand skill in application and selection of patients (monoga-mous, preferably parous) to avoid infection that is increased only around insertion. Emergency postcoital contraception in the form of high dose combined pill or high dose progestins or insertion of IUD is effective and should be widely available. Teenage pregnancy is a serious health problem of modern societies and contraception in this age group demands special non-didactic counseling, education and parent involvement. The pill or/and condom are the methods used commonly.

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Cotard's syndrome. A three-case report

Hippokratia 2005; 9(1):41-44

A Vaxevanis, A Vidalis
Psychiatric Dpt, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

One hundred and twenty years after the description of the syndrome by the French doctor Jules Cotard and while the relevant terms can’t be found in the modern diagnostic array, the question of whether the clinical state corresponds to a special nosologic being or whether it is an important indicator of seriousness or chronicity seems to remain unanswered. The syndrome appeared as case report more than 200 times over the last century according to international literature. However, there has been a dramatic decline in the appearance of it recently, probably due to the psycho-pharmacological treatment approach or/and because of the decrease in the number of institutionalized patients. In the present study we describe three cases where it seems that the emotional consistence of the syndrome and, on the other hand, its connection with chronicity/ negligence of psychic disorder need to be taken into account.

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End-stage renal failure and referral for dialysis in the F.Y.R.M.

Hippokratia 2005; 9 (1):45-48

O. Stojceva - Taneva, N Ivanovski, G Selim, K Zafirovska, R Grozdanovski
Nephrology Dpt, Clinical Center, University "St. Cyril and Methodius", Skopje, F.Y.R.M.

Abstract

Background. Starting in 1999, the Outpatient Clinic of the Department of Nephrology in Skopje has conducted a prospective survey on the incidence of end-stage renal failure (ESRF) patients requiring renal replacement therapy (RRT) in the whole country, including late, as well as early referrals that have been followed up by nephrologists.
Methods: A total of 168 ESRF patients have been accepted for RRT in 1999 in the F.Y.R.M, 156 in Skopje and 12 in Struga. Data have been obtained from the medical records of all the patients in Skopje, and complete laboratory data have been obtained from 136 patients in Skopje that have been statistically analyzed.
Results: Sixteen out of 168 patients died during their hospitalization during the first month after starting RRT, so 140 patients continued on maintenance hemodialysis in Skopje and 12 in Struga, a total of 152, or an incidence of 76 / milion population. The male / female ratio was 45.5 / 54.5%. The number of late referrals was incredibly high, 79.5% compared to early ones, 20.5%. The early referrals had a significantly higher endogenous creatinine clearance (Ccr) and calculated Ccr at start of RRT, 7.7±3.5 and 9,2±5.4 ml / min, respectively, compared to the late ones, 6.1±4.3 and 7.02±3.9 ml / min respectively, p< 0.05. The group of patients who died during hospitalization were significantly older than those who survived, 61.1±15.8 compared to 54.3± 14.2 years, and had lower albumin levels, 30.6±6.5 g / l compared to 34.7±6.4 g / l, p < 0.05. Of the 16 patients who died, 14 were from the late referrals, and only 2 from the early ones, p < 0.05. Patients with diabetic nephropathy started RRT with a significantly higher Ccr and calculated Ccr compared to other causes of ESRF, 8.4±3.3 and 11.7±6.5 ml / min respectively, compared to 5.7±4.2 and 6.3±2.6 ml / min respectively, p < 0.01 and p < 0.000000.
Conclusions: The number of late referrals of patients with ESRF, to nephrologists, for RRT in F.Y.R.M. is extremely high and the initiation of RRT is not optimal, affecting early morbidity and mortality of ESRF patients.

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