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Bamias A, Tzannis K, Zakopoulou R, Sakellakis M, Dimitriadis J, Papatheodoridi A, Rallidis L, Halvatsiotis P, Tsiara A, Kaparelou M, Kostouros E, Barbarousi D, Koutsoukos K, Fragiadis E, Dellis AE, Anastasiou I, Stravodimos K, Pinitas A, Papatsoris A, Adamakis I, Varkarakis I, Fragoulis C, Pagoni S, Matsouka C, Skolarikos A, Mitropoulos D, Doumas K, Deliveliotis C, Constantinides C, Dimopoulos MA. Risk for Arterial Thromboembolic Events (ATEs) in Patients with Advanced Urinary Tract Cancer (aUTC) Treated with First-Line Chemotherapy: Single-Center, Observational Study. Curr Oncol 2022; 29:6077-6090. [PMID: 36135047 PMCID: PMC9498031 DOI: 10.3390/curroncol29090478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Arterial thromboembolism has been associated with cancer or its treatment. Unlike venous thromboembolism, the incidence and risk factors have not been extensively studied. Here, we investigated the incidence of arterial thromboembolic events (ATEs) in an institutional series of advanced urinary tract cancer (aUTC) treated with cytotoxic chemotherapy. The ATE definition included peripheral arterial embolism/thrombosis, ischemic stroke and coronary events. A total of 354 aUTC patients were analyzed. Most patients (95.2%) received platinum-based chemotherapy. A total of 12 patients (3.4%) suffered an ATE within a median time of 3.6 months from the start of chemotherapy. The most frequent ATE was ischemic stroke (n = 7). Two ATEs were fatal. The 6-month and 24-month incidence were 2.1% (95% confidence interval [CI]: 0.9–4.1) and 3.6% (95% CI: 1.9–6.2), respectively. Perioperative chemotherapy increased the risk for ATE by 5.55-fold. Tumors other than UTC and pure non-transitional cell carcinoma histology were also independent risk factors. No association with the type of chemotherapy was found. Overall, ATEs occur in 4.6% of aUTC patients treated with chemotherapy and represent a clinically relevant manifestation. Perioperative chemotherapy significantly increases the risk for ATE. The role of prophylaxis in high-risk groups should be prospectively studied.
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Affiliation(s)
- Aristotelis Bamias
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
- Correspondence: ; Tel.: +30-21-0583-1255; Fax: +30-21-0532-6454
| | - Kimon Tzannis
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
| | - Roubini Zakopoulou
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Minas Sakellakis
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
| | - John Dimitriadis
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Alkistis Papatheodoridi
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Loukianos Rallidis
- 2nd Department of Cardiology, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
| | - Panagiotis Halvatsiotis
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
| | - Anna Tsiara
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Maria Kaparelou
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Efthymios Kostouros
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Despina Barbarousi
- Haematology Division, Alexandra Hospital, Vasilissis Sofias 80, 11528 Athens, Attiki, Greece
| | - Konstantinos Koutsoukos
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Evangelos Fragiadis
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Athanasios E. Dellis
- 2nd Dept of Surgery, Aretaieion Academic Hospital, National & Kapodistrian University of Athens, Vas. Sofias Ave 76, 11528 Athens, Attiki, Greece
| | - Ioannis Anastasiou
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Konstantinos Stravodimos
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Alexandros Pinitas
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Athanasios Papatsoris
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Ioannis Adamakis
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Ioannis Varkarakis
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Charalampos Fragoulis
- Department of Urology, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Stamatina Pagoni
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Charis Matsouka
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Andreas Skolarikos
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Dionysios Mitropoulos
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Konstantinos Doumas
- Department of Urology, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Charalampos Deliveliotis
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Constantinos Constantinides
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Meletios-Athanasios Dimopoulos
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
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Karlafti E, Benioudakis ES, Barouxi E, Kaiafa G, Didangelos T, Fountoulakis KN, Pagoni S, Savopoulos C. Exhaustion and burnout in the healthcare system in Greece: A cross-sectional study among internists during the COVID-19 lockdown. Psychiatriki 2022; 33:21-30. [PMID: 35255472 DOI: 10.22365/jpsych.2022.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has rapidly changed everyday life around the world. The situation created by the COVID-19 pandemic has been shown to be associated with severe mental health problems in frontline medical and nursing staff. The aim of this study was to investigate exhaustion, disengagement, secondary traumatic stress, compassion satisfaction, burnout, as well as depression, anxiety and stress among internists in Greece, during the second lockdown period. Internists were approached through the Internal Medicine Society of Greece and a total of 117 participated in the study (response rate: 15.3%). The participants responded through a Google form on the Depression, Anxiety and Stress Scale - 21, the Oldenburg Burnout Inventory (OLBI) and the Professional Quality of Life Scale version 5 (ProQOL-5). Exhaustion was found in the majority of the participants (88%), 65.8% met the criteria for at least moderate levels of compassion satisfaction and 71.8% presented moderate levels of burnout. Furthermore, about half of the participants met the criteria for moderate to extremely severe levels of depression, anxiety and stress. Finally, regression analyses showed that depression was associated with both the OLBI and ProQOL-5 scales. The majority of the internists, during the lockdown period in Greece, were evaluated as "exhausted", with high rates of negative psychological symptoms. The present study, despite the limitations, highlights the impact of the COVID-19 pandemic on internists, which triggered a shift in attention onto the treatment, and especially the prevention, of stressful situations for health professionals.
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Affiliation(s)
- Eleni Karlafti
- First Propeadeutic Internal Medicine Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil S Benioudakis
- First Propeadeutic Internal Medicine Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Barouxi
- Department of Psychology, University of Crete, Rethimno, Greece
| | - Georgia Kaiafa
- First Propeadeutic Internal Medicine Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Triantafyllos Didangelos
- First Propeadeutic Internal Medicine Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos N Fountoulakis
- Third Department of Psychiatry, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stamatina Pagoni
- Third Department of Internal Medicine, "G. Gennimatas" General Hospital of Athens, Greece
| | - Christos Savopoulos
- First Propeadeutic Internal Medicine Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kaiafa G, Veneti S, Polychronopoulos G, Pilalas D, Daios S, Kanellos I, Didangelos T, Pagoni S, Savopoulos C. Is HbA1c an ideal biomarker of well-controlled diabetes? Postgrad Med J 2020; 97:380-383. [PMID: 32913038 DOI: 10.1136/postgradmedj-2020-138756] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022]
Abstract
HbA1c is a biomarker with a central role in the diagnosis and follow-up of patients with diabetes, although not a perfect one. Common comorbidities encountered in patients with diabetes mellitus, such as renal insufficiency, high output states (iron deficiency anaemia, haemolytic anaemia, haemoglobinopathies and pregnancy) and intake of specific drugs could compromise the sensitivity and specificity of the biomarker. COVID-19 pandemic poses a pressing challenge for the diabetic population, since maintaining optimal blood glucose control is key to reduce morbidity and mortality rates. Alternative methods for diabetes management, such as fructosamine, glycosylated albumin and device-based continuous glucose monitoring, are discussed.
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Affiliation(s)
- Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stavroula Veneti
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - George Polychronopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stylianos Daios
- Internal Medicine Department, General Hospital of Serres, Greece
| | - Ilias Kanellos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Triantafyllos Didangelos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stamatina Pagoni
- 3rd Department of Internal Medicine, "G. Gennimatas" General Hospital of Athens, Greece.,Hellenic Society of Internal Medicine, Athens, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
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Voulgari C, Paximadas S, Pagoni S. Prevalence Of Ischemic Stroke Risk Factors During Greek Economic Crisis. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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5
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Voulgari C, Pagoni S. Relationship Between Everyday Activity And Prediabetes In Nonobese Adolescents. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kyriazoglou A, Liontos M, Papadopoulos C, Bilali A, Kostouros E, Pagoni S, Doumas K, Dimopoulos MA, Bamias A. Guillain-Barré Syndrome Related to Nivolumab: Case Report of a Patient With Urothelial Cancer and Review of the Literature. Clin Genitourin Cancer 2019; 17:e360-e364. [DOI: 10.1016/j.clgc.2018.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022]
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Bamias A, Tsironis G, Dimitriadis I, Tzanis K, Tsiara A, Xirokosta A, Kaparelou M, Kyriazoglou A, Cohen A, Barbarousi D, Koutsoukos K, Liontos M, Zakopoulou R, Kostouros E, Pagoni S, Matsouka C, Dimopoulos MA. Risk for vascular thromboembolic events (VaTEs) in patients (pts) with advanced urinary tract cancer (aUTC) treated with chemotherapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
383 Background: Venous thromboembolism (VTE) is a frequent complication of cancer or its treatment. Khorana (KRS) and Compass scores are two Risk Assessment Models for VTE. However, aUTC was not adequately represented and arterial events were not included, in these models. Methods: Data from pts with aUTC treated with at least one line of chemotherapy in our institution were analyzed. VaTE definition included: DVT and PE defined as venous events and peripheral arterial thrombosis or embolus, ischemic stroke and coronary events, grouped as arterial events. The association of baseline and treatment-related factors with the development of VaTE was assessed using competing-risk regressions. According to the results of our multivariate analysis we stratified patients according to the number of the identified risk factors. Results: 354 aUTC pts treated between 4/1995 and 9/2015 entered our study. 53% of pts had received cisplatin and 42% carboplatin-based regimens. 44 pts (12.4%) suffered 45 VaTEs (13 arterial, 32 venous) within a median time of 3.3 months. The cumulative and 6-month incidence was 14.8% (95% CI: 10.9-19.4) and 9.7% (95% CI: 6.8-13.1), [venous 10.5% (95% CI: 7.3-14.3)/7.5% (95% CI: 5-10.7); arterial 5.3% (95% CI: 2.8-9)/2.7% (95% CI: 1.3-5), respectively]. No association of the KRS and the COMPASS score with the incidence of VaTEs was observed. In the univariate and multivariate analysis, cumulative VaTE incidence was significantly increased in pts with “peripheral arterial disease (PAD) or history of VΤE” (adjusted SHR: 3.29; 95% CI: 1.65-6.55; p=0.001) and pts with other solid tumor (SHR: 2.20; 95% CI: 1.05-4.62; p=0.038). There was a strong correlation between the number of risk factors and the risk for VaTE development (p<0.001). Patients with 1 or 2, vs 0 factors had a 3-fold increased risk [cumulative incidence was 10.9% (95% CI: 7.4.-15.2) and 30.2% (95% CI: 18.4-42.8), respectively; SHR: 3.01 95% CI: 1.65-5.51]. Conclusions: Development of tumor-specific algorithms for the risk of vascular events is supported by our results. Pts with aUTC and a history of VTE, PAD and other solid tumor have a very high risk for VaTE. The role of prophylaxis should be prospectively studied.
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Affiliation(s)
- Aristotelis Bamias
- Haematology- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Tsironis
- Haematology- Oncology Unit, Dept. of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Dimitriadis
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon Tzanis
- Hellenic Genitourinary Cancer Group (HGUCG), Athens, Greece
| | - Anna Tsiara
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Kaparelou
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Kyriazoglou
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Abis Cohen
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Koutsoukos
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Michael Liontos
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Roubini Zakopoulou
- Haematology- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Euthymios Kostouros
- Haematology- Oncology Unit, Department Of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatina Pagoni
- Third Department of Internal Medicine, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | | | - Meletios A. Dimopoulos
- Haematology- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Giannopoulos G, Kossyvakis C, Angelidis C, Panagopoulou V, Tsiachris D, Vrachatis DA, Doudoumis K, Letsas K, Pagoni S, Stefanadis C, Vassilikos VP, Lekakis J, Deftereos S. Coincidental ganglionated plexus modification during radiofrequency pulmonary vein isolation and post-ablation arrhythmia recurrence. Europace 2018; 19:1967-1972. [PMID: 29194518 DOI: 10.1093/europace/euw309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/03/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Vagal responses (VR) during left atrial ablation for atrial fibrillation (AF) treatment have been reported to be associated with less recurrences, presumably because they are a sign of ganglionated plexi modification. Our objective was to evaluate whether coincidentally elicited VR during left atrial ablation are associated with lower AF recurrence rates. Methods and results This is a post hoc analysis of a prospective study of 291 patients with paroxysmal AF undergoing radiofrequency pulmonary vein isolation (PVI). Vagal responses were defined as episodes of heart rate <40 bpm or asystole lasting >5 s elicited during energy application. Sixty-eight patients (23.4%) had a VR during ablation. In Kaplan-Meier analysis, mean recurrence-free survival was 449 days (95% confidence interval 411-488) in patients with VR when compared with 435 days (95% confidence interval 415-455) in those without (P = 0.310). The 12-month recurrence rate estimates were 25 and 27%, respectively. In an unadjusted Cox model, VR was associated with an odds ratio for recurrence of 0.77 (95% confidence interval 0.46-1.28). Conclusion Coincidentally elicited VR during radiofrequency PVI in patients with paroxysmal AF do not appear to be related to lower risk of arrhythmia recurrence. This may mean that, even if a VR is truly a sign of coincidental ablation of a ganglionated plexus, this does not necessarily mean that a therapeutic modification has been effected, at least to a degree associated with clinical benefit.
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Affiliation(s)
- Georgios Giannopoulos
- 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece.,Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.,Athens Heart Center, Athens Medical Center, Athens, Greece
| | - Charalampos Kossyvakis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.,Cardiology Department, Athens General Hospital 'G. Gennimatas', Athens, Greece
| | - Christos Angelidis
- 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Vasiliki Panagopoulou
- 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | | | | | | | | | - Stamatina Pagoni
- Cardiology Department, Athens General Hospital 'G. Gennimatas', Athens, Greece
| | | | - Vassilios P Vassilikos
- 3rd Department of Cardiology, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Greece
| | - John Lekakis
- 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece.,Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
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9
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Kallistratos M, Giannitsi S, Vasilopoulou E, Poulimenos L, Iliou K, Koukouzeli A, Kouremenos N, Chamodraka E, Skyrlas A, Kontogiannis N, Pagoni S, Daskalaki A, Kyfnidis K, Tsinivizov P, Manolis A. [PP.14.23] J CURVE PHENOMENON. AN ANALYSIS OF BLOOD PRESSURE AND CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS WITH CORONARY ARTERY DISEASE AND IMPAIRED SYSTOLIC FUNCTION. J Hypertens 2017. [DOI: 10.1097/01.hjh.0000523571.85572.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Ptohis ND, Charalampopoulos G, Abou Ali AN, Avgerinos ED, Mousogianni I, Filippiadis D, Karydas G, Gravanis M, Pagoni S. Contemporary Role of Embolization of Solid Organ and Pelvic Injuries in Polytrauma Patients. Front Surg 2017; 4:43. [PMID: 28824919 PMCID: PMC5545602 DOI: 10.3389/fsurg.2017.00043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/20/2017] [Indexed: 11/21/2022] Open
Abstract
Abdominopelvic trauma (APT) remains a leading cause of morbidity and mortality in the 15- to 44-year-old age group in the Western World. It can be life-threatening as abdominopelvic organs, specifically those in the retroperitoneal space, can bleed profusely. APT is divided into blunt and penetrating types. While surgery is notably considered as a definitive solution for bleeding control, it is not always the optimum treatment for the stabilization of a polytrauma patient. Over the past decades, there has been a shift toward more sophisticated strategies, such as non-operative management of abdominopelvic vascular trauma for haemodynamically stable patients. Angiographic embolization for bleeding control following blunt and/or penetrating intra- and retroperitoneal injuries has proven to be safe and effective. Embolization can achieve hemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolization techniques has widened the indications for non-operative treatment in solid organ injury. Moreover, advances in computed tomography provided more efficient scanning times with improved image quality. While surgery is still usually recommended for patients with penetrating injuries, non-operative management can be effectively used as well as an alternative treatment. We review indications, technical considerations, efficacy, and complication rates of angiographic embolization in APT.
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Affiliation(s)
- Nikolaos D Ptohis
- Department of Interventional Radiology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Georgios Charalampopoulos
- Second Department of Radiology, General University Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Adham N Abou Ali
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Iliana Mousogianni
- Department of Interventional Radiology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Dimitrios Filippiadis
- Second Department of Radiology, General University Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Karydas
- Department of Interventional Radiology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Miltiadis Gravanis
- Department of Interventional Radiology, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - Stamatina Pagoni
- Third Department of Internal Medicine, General Hospital of Athens "G. Gennimatas", Athens, Greece
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Vrachatis DA, Giannopoulos G, Kossyvakis C, Panagopoulou V, Vavuranakis M, Papaioannou TG, Pagoni S, Pyrgakis VN, Cleman MW, Deftereos SG. Peri-procedural Anticoagulation in Catheter Ablation for Atrial Fibrillation: A Review. Curr Pharm Des 2016; 23:1334-1345. [PMID: 27917710 DOI: 10.2174/1381612822666161205115101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/25/2016] [Indexed: 11/22/2022]
Abstract
Catheter ablation for rhythm control in atrial fibrillation has been recognized as an established treatment. Patients with atrial fibrillation suffer from an increased risk of thromboembolic events. Long-term stroke risk and mortality have been shown to be reduced after catheter ablation, still the procedure per se is associated with an additive peri-procedural thromboembolic risk. Maintenance of the thrombotic - bleeding equilibrium in such patients during interventional procedures is compelling. Lack of data from randomized studies along with the recent introduction of novel oral anticoagulants in clinical practice has resulted in a wide variance of antithrombotic treatment approaches. Procedural interruption of anticoagulants, switching of anticoagulation scheme (i.e. from novel oral anticoagulants to vitamin K antagonists), bridging with heparin, timing of re-initiation of therapy and/or utilization of novel oral anticoagulants have all been points of dispute. In the present review we present the available data regarding optimal peri-procedural anticoagulation strategies in patients undergoing catheter ablation for atrial fibrillation.
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Affiliation(s)
- Dimitrios A Vrachatis
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, 154 Mesogion ave., 115 27, Athens, Greece
| | - Georgios Giannopoulos
- Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Greece
| | - Charalambos Kossyvakis
- Section of Cardiovascular Medicine, Yale University School of Medicine, CT, United States
| | - Vasiliki Panagopoulou
- Section of Cardiovascular Medicine, Yale University School of Medicine, CT, United States
| | - Manolis Vavuranakis
- Department of Cardiology, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore G Papaioannou
- Department of Cardiology, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatina Pagoni
- Department of Internal Medicine, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Vlasios N Pyrgakis
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Michael W Cleman
- Section of Cardiovascular Medicine, Yale University School of Medicine, CT, United States
| | - Spyridon G Deftereos
- Section of Cardiovascular Medicine, Yale University School of Medicine, CT, United States
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Abstract
And suddenly, following the preliminary results of renal denervation and carotid baroreceptor stimulation, a big interest in resistant hypertension rose, and all interventionists, many of them with no previous experience with hypertension, fell in love with hypertension and especially resistant hypertension. In the European Society of Hypertension/International Society of Hypertension (ESH/ISH) 2014 Joint Hypertension meeting in Athens, there were no more than four to five sessions related to resistant hypertension and renal denervation, while in the 2014 EuroPCR meeting there were more than 60 renal denervation sessions! In light of the growing scientific interest in the treatment of this patient group, an update on the treatment available and some concerns regarding the definition and treatment of resistant hypertension is presented.
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Affiliation(s)
- Athanasios J. Manolis
- Asklepeion General Hospital, Cardiology department1 Vassileos Pavlou Ave Voula, Athens, 16673Greece
| | - Manolis S. Kallistratos
- Asklepeion General Hospital, Cardiology department1 Vassileos Pavlou Ave Voula, Athens, 16673Greece
| | - Michalis Doumas
- Hippokration Hospital, Aristotle UniversityThessalonikiGreece
| | | | - Leonidas Poulimenos
- Asklepeion General Hospital, Cardiology department1 Vassileos Pavlou Ave Voula, Athens, 16673Greece
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Abstract
The ventricular gradient (VG) as a concept was conceived in the 1930s and its calculation yielded information that was not otherwise obtainable. The VG was not utilized by clinicians at large because it was not easy to understand and its computation time-consuming. The contemporary spatial QRS-T angle is based on the concept of the VG and defined as its mathematical and physiological integral. Its current major clinical use is to assess the cardiac primary repolarization abnormalities in 3-dimensional spatial vectorial plans which are normally untraced in the presence of secondary electrophysiological activity in a 2-dimensional routine electrocardiogram (ECG). Currently the calculation of the spatial QRS-T angle can be easily computed on the basis of a classical ECG and contributes to localization of arrhythmogenic areas in the heart by assessing overall and local heterogeneity of the myocardial ventricular action potention duration. Recent population-based studies suggest that the spatial QRS-T angle is a dominant ECG predictor of future cardiovascular events and death and it is superior to more conventional ECG parameters. Its assessment warrants consideration for intensified primary and secondary cardiovascular prevention efforts and should be included in everyday clinical practice. This review addresses the nature and diagnostic potential of the spatial QRS-T angle. The main focus is its role in ECG assessment of dispersion of repolarization, a key factor in arrythmogeneity.
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Affiliation(s)
- Christina Voulgari
- First Department of Propaudeutic Internal Medicine, “Laiko” General Hospital, Athens University Medical School, Greece.
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Voulgari C, Pagoni S, Vinik A, Poirier P. Exercise improves cardiac autonomic function in obesity and diabetes. Metabolism 2013; 62:609-21. [PMID: 23084034 DOI: 10.1016/j.metabol.2012.09.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/19/2012] [Accepted: 09/11/2012] [Indexed: 02/07/2023]
Abstract
Physical activity is a key element in the prevention and management of obesity and diabetes. Regular physical activity efficiently supports diet-induced weight loss, improves glycemic control, and can prevent or delay type 2 diabetes diagnosis. Furthermore, physical activity positively affects lipid profile, blood pressure, reduces the rate of cardiovascular events and associated mortality, and restores the quality of life in type 2 diabetes. However, recent studies have documented that a high percentage of the cardiovascular benefits of exercise cannot be attributed solely to enhanced cardiovascular risk factor modulation. Obesity in concert with diabetes is characterized by sympathetic overactivity and the progressive loss of cardiac parasympathetic influx. These are manifested via different pathogenetic mechanisms, including hyperinsulinemia, visceral obesity, subclinical inflammation and increased thrombosis. Cardiac autonomic neuropathy is an underestimated risk factor for the increased cardiovascular morbidity and mortality associated with obesity and diabetes. The same is true for the role of physical exercise in the restoration of the heart cardioprotective autonomic modulation in these individuals. This review addresses the interplay of cardiac autonomic function in obesity and diabetes, and focuses on the importance of exercise in improving cardiac autonomic dysfunction.
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Affiliation(s)
- Christina Voulgari
- 3rd Department of Internal Medicine, Athens Regional General Hospital G.Gennimatas, University Medical School, Athens, Greece.
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Abstract
By definition, brittle diabetes (BD) is an unstable condition. Patients with BD suffer chronically from poor metabolic control, characterized by severe instability of glycemic values with frequent and unpredictable hypoglycemic and/or diabetic ketoacidosis episodes that cannot be attributed to failure in management. Quality of life is dramatically compromised because of very frequent acute complications leading to hospital admissions and because of premature chronic complications. It remains difficult to identify all patients with BD as diagnostic criteria are still not well defined. In practice, metabolic instability is manifested most obviously by chaotic glycemic profiles, which show greater and more unpredictable variation than in "stable" patients with diabetes. It is important that patients with BD are not adequately controlled, even by closely supervised, intensive insulin regimens, including continuous subcutaneous and/or intravenous insulin infusion. Their care is often very expensive in terms of time and resources, and their lives are constantly at risk for severe metabolic derangement. Management can also be frustrating and demoralizing for everyone involved, including the patient's family as well as the diabetes care team. Adopting a team approach, involving a broad range of disciplines, is essential in treating patients with BD and helping them to achieve and maintain both normoglycemia and quality of life.
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Affiliation(s)
- Christina Voulgari
- 3rd Department of Internal Medicine, Athens Regional General Hospital G Gennimatas, University Medical School, Athens, Greece.
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Pagoni S, Charalampopoulos C, Syrigos D, Zoulias E, Voulgari C, Papalimneou B, Mousouli A, Paximadas S. MS532 ASSOCIATION BETWEEN Lp(a) AND HDL CHOLESTEROL ON GENERAL POPULATION. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)71032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pagoni S, Paximadas S, Syrigos D, Koutete D, Vrionis S, Pilios J, Koukou E, Kordalis A. Abstract: P769 THE LIPID PROFILE AND TROPONIN I LEVELS ON PROGRESS IN PATIENTS WITH LATTER THROMBOTIC STROKE. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70925-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liatis S, Marinou K, Tentolouris N, Pagoni S, Katsilambros N. Usefulness of a new indicator test for the diagnosis of peripheral and autonomic neuropathy in patients with diabetes mellitus. Diabet Med 2007; 24:1375-80. [PMID: 17941862 DOI: 10.1111/j.1464-5491.2007.02280.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS The aim of the present study was to assess the performance of a new indicator test (NIT), based on the measurement of sweat production after exposure to dermal foot perspiration, in the diagnosis of both peripheral sensorimotor polyneuropathy (PSN) and autonomic neuropathy in patients with diabetes. METHODS One hundred and seventeen diabetic patients were examined. PSN was assessed using the neuropathy symptoms score, the neuropathy disability score and the vibration perception threshold. Cardiac autonomic neuropathy (CAN) was assessed using the battery of the four classical standardized tests proposed by Ewing et al., Diabetes Care 1985; 8: 491-498. Sudomotor dysfunction was assessed using the NIT. RESULTS Fifty patients (42.7%) had PSN and 44 patients (37.6%) had CAN. Of the 50 patients with PSN, 43 had a positive NIT (sensitivity 86%) and, out of the 67 patients without PSN, a negative NIT was obtained in 45 patients (specificity 67%). The positive and the negative predictive value of the NIT in detecting PSN were 66.2 and 86.5%, respectively. The sensitivity and specificity of NIT in detecting CAN was 59.1 and 46.5%, respectively. In the case of severe CAN, the sensitivity was increased to 80.9% and the specificity to 50%. CONCLUSIONS The NIT has good sensitivity and negative predictive value for diagnosis of PSN and can be used as a screening method for detection of this complication in patients with diabetes. In addition, the test has a low sensitivity for detection of autonomic neuropathy in patients with milder forms of CAN.
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Affiliation(s)
- S Liatis
- First Department of Internal Medicine, Athens University Medical School and Diabetes Centre, Laiko General Hospital, Athens, Greece.
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Paximadas S, Pagoni S, Chatziantonakis N, Mavrodimitrakis I, Barmpouletos D, Syrigos D, Rousodimos K. PO16-473 METABOLIC SYNDROME AND CVD IN ISLAND LEMNOS GREECE POPULATION. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pagoni S, Paximadas S, Vagena M, Rousodimos K, Nikitopoulou P, Kalokerinos G, Katsigianni G. Tu-P10:400 The significance of homocysteine on diabetus mellitus. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Paximadas S, Pagoni S, Nikitopoulou P, Kalokerinos G, Katsigianni G, Kalompokis B. Mo-P4:288 The diabetes melitus as main risk factor for stroke in Island Lemnos Greece population. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tsapogas P, Tentolouris N, Kokkinos A, Papazafiropoulou A, Liatis S, Tsiakou A, Pagoni S, Katsilambros N. Identifizierung des Metabolischen Syndromes bei Patienten mit Diabetes mellitus Typ 1 bzw. 2 und nichtdiabetischen Personen gemäss den IDF- und NCEP-ATPIII-Kriterien. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Paximadas S, Pagoni S, Kosmidis M, Tsarouchas X, Matsoukas C, Demou D. M.614 Homocysteine as an independent risk factor for cardiovascular disease. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90612-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Background: Peripheral somatic and autonomic neuropathies are the most common types of diabetic polyneuropathy. Although duration and degree of hyperglycemia are considered to be risk factors for both autonomic and peripheral neuropathy, recent studies have raised the question of a different development and natural history of these neuropathies in diabetes. In addition, a few studies have investigated the relationship between chronic painful and autonomic neuropathy. The aim of this study was to investigate to what extent autonomic and peripheral neuropathy coexist, as well as whether painful neuropathy is more common in diabetic patients with autonomic neuropathy. Methods: Subjects with type 1 (n=52; mean age 31.7 years) and type 2 diabetes (n=53; mean age 54.5 years) were studied. Evaluation of peripheral neuropathy was based on clinical symptoms (neuropathic symptom score), signs (neuropathy disability score), and quantitative sensory testing (vibration perception threshold). Assessment of autonomic neuropathy was based on the battery of standardized cardiovascular autonomic function tests. Results: Prevalence rates of pure autonomic and of pure peripheral neuropathy in patients with type 1diabetes were 28.8 and 13.5%, respectively. The respective rates in patients with type 2 diabetes were 20.7% (P=0.33 vs. type 1 diabetes) and 20.7% (P=0.32). Peripheral and autonomic neuropathy coexisted in 28.8% of type 1 and in 45.3% of type 2 diabetic subjects (P=0.08). Prevalence rates of chronic painful neuropathy in subjects with type 1 diabetes, with and without autonomic neuropathy, were 16.6 and 22.7%, respectively (P=0.85) and in type 2 diabetic subjects 20 and 22.2%, respectively (P=0.58). Multivariate analysis after adjustment for age, sex, blood pressure, duration of diabetes, HBA(1c), and presence of retinopathy or microalbuminuria showed that neither the indices of peripheral nerve function (neuropathic symptom score, neuropathy disability score, vibration perception threshold) nor the presence of peripheral neuropathy or chronic painful neuropathy are associated with the presence of autonomic neuropathy in individuals with either type 1 or type 2 diabetes. Conclusions: Peripheral and autonomic neuropathies do not invariably coexist in diabetes. In addition, chronic painful neuropathy may be present irrespective of the presence of autonomic neuropathy.
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Affiliation(s)
- N Tentolouris
- First Department of Propaedeutic Medicine, Athens University Medical School, 'Laiko' Hospital, 17 Ag. Thoma, GR-115 27, Athens, Greece
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Skoumas J, Pitsavos C, Doulalas A, Kouloulias B, Toutouza M, Giotsas N, Pagoni S, Vaina S, Lambrou S, Stefanadis C, Toutouzas P. 2.P.146 Differentiation of plasma lipoprotein (a) in a population of 1989 Greek army recruits. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Skoumas J, Pitsavos C, Toutouza M, Paximadas S, Pagoni S, Skoumbourdis E, Vaina S, Dernellis J, Stefanadis C, Toutouzas P. 1.P.133 Differentiation of thrombotic factors in phenotypes of familial combined hyperlipidaemia. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88311-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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