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Psychiatric patient with Chilaiditi's syndrome. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2018:CSRP.VAMA.061518. [PMID: 29944423 DOI: 10.3371/csrp.vama.061518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chilaiditi's sign is defined as the interposition of bowels between the liver and the right diaphragm. When the patient is symptomatic due to the intestinal obstruction, the case is referred to as Chilaiditi's syndrome. OBJECTIVE To emphasize the importance of accurate diagnose of Chilaiditi's syndrome in patients with psychotic disturbances. METHOD A 46 years old male was admitted to our department suffering from a constant epigastric and right upper quadrant pain with radiation to the right shoulder. The pain started 10 hours before the admission of the patient and was accompanied with vomiting. Patient has a history of schizophrenia and intellectual disability. He was in a stimulatory situation and unable to give any information about his state of health. RESULTS Patient was afebrile, tachycardic and laboratory results were normal. The chest and abdomen x-ray showed the Chilaiditi's sign. With the ultrasound procedure the case of the pneumoperitoneum was excluded. A conservative treatment with IV fluid hydration, pain management, diet modification, laxatives and enemas, was used. After a week of hospitalization, the patient felt well, having proper diet and regular evacuations and at the Chilaiditi's sign was no more observed. DISCUSSION The etiology of the Chilaiditi's syndrome is multifactoral and it has been reported that it is associated with psychotropic medication and intellectual disability. CONCLUSIONS The diagnosis of the syndrome is vital in order to avoid unnecessary and dangerous surgical interventions. Only few publications of a Chilaiditi syndrome in patients with psychosis are cited in the literature.
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Effect of under- and overfeeding on sheep and goat milk and plasma enzymes activities related to oxidation. J Anim Physiol Anim Nutr (Berl) 2017; 102:e288-e298. [PMID: 28508581 DOI: 10.1111/jpn.12741] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/11/2017] [Indexed: 12/28/2022]
Abstract
Twenty-four dairy sheep and goats, respectively, were assigned each to three homogenous subgroups per animal species and fed the same diet in quantities which met 70% (underfeeding), 100% (control) and 130% (overfeeding) of their energy and crude protein requirements. The results showed that the underfed sheep in comparison with the control had significantly lower glutathione reductase (GR), superoxide dismutase (SOD), catalase and glutathione peroxidase (GPX) activities and total antioxidant capacity (measured with Ferric Reducing Ability of Plasma [FRAP] assay) in their blood plasma. A significant increase in the glutathione transferase (GST) and GPX activities, malondialdehyde content and total antioxidant capacity (measured with 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) [ABTS] assay) in the blood plasma of underfed goats compared with controls was observed, while the opposite happened for the GR and SOD activities. The underfeeding in both animal species caused a significant increase in the protein carbonyls (PC) content of their blood plasma. The overfeeding, compared with the control, caused a significant decline in the GPX activity and total antioxidant capacity (measured with FRAP) in the blood plasma of sheep while the opposite happened for the GPX and GST activities in the case of goats. The overfed animals, of both species, compared with the respective controls, had higher PC content in their blood plasma. The feeding level had no noticeable impact on the antioxidants' enzymes activities of milk in both animal species. Moreover, the underfeeding in the blood plasma and the overfeeding in milk of both animal species resulted into a significant increase in the PC content. Finally, only in sheep milk, the underfeeding, compared with the respective control, and overfeeding reduced significantly the total antioxidant capacity (measured with ABTS). The feeding level caused oxidative stress in both organism and milk but the response was different in animal species and needs further investigation.
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Inter-arm coordination and intra-cyclic variation of the hip velocity during front crawl resisted swimming. J Sports Med Phys Fitness 2013; 53:612-619. [PMID: 24247185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The aim of the study was to assess the acute effect of front crawl sprint resisted swimming on the inter-arm coordination and the fluctuation of the swimming velocity. METHODS Nine female swimmers swam four all-out trials of 25 m, without and with low, moderate and high added resistance. Four camcorders were used to record the underwater movement. The inter-arm coordination was quantified using the index of coordination and the hip intra-cyclic velocity variation was analysed by calculating the coefficient of variation and the difference between the maximum and minimum velocities normalized for the mean stroke cycle velocity. RESULTS One-way repeated measures analyses of variance showed that swimmers change their inter-arm coordination from a "catch up" toward an "opposition" mode. Concerning the hip horizontal intra-cyclic velocity variation, it was increased significantly during resisted swimming. CONCLUSION These findings indicate that although resisted swimming cause an increase in the index of coordination and consequently it could be speculated a better propulsive continuity, the velocity fluctuations of the hip within a stroke cycle are not decreased, probably due to the inability of the swimmers to overcome effectively the concrete added resistances used in this study. Thus, at least concerning its acute effect, the hypothesis that the sprint resisted swimming could led to a technical improvement can not be satisfied.
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Peripheral neuropathy is associated with increased mean platelet volume in type 2 diabetic patients. Platelets 2009; 16:498-9. [PMID: 16287617 DOI: 10.1080/09537100500384723] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Inflammatory cytokines in insulin-treated patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2008; 18:471-476. [PMID: 17976964 DOI: 10.1016/j.numecd.2007.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 01/18/2007] [Accepted: 02/25/2007] [Indexed: 01/04/2023]
Abstract
OBJECTIVE An association between type 2 diabetes mellitus and inflammation has been described in several studies. The aim of this study was to search for the presence of low-grade inflammation in a special group of insulin-treated patients with type 2 diabetes, and to investigate a possible correlation between inflammation and obesity, glucose homeostasis and insulin requirement (IU insulin/kg body weight, BW). METHODS We studied 85 subjects with type 2 diabetes that were receiving insulin treatment (group A) and 32 receiving sulfonylurea treatment (group B), and 57 subjects without diabetes (group C). Interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha), and the soluble TNF-alpha receptors sTNFR-60 and sTNFR-80 were measured in serum samples taken from all patients. RESULTS The mean serum cytokine levels in group A vs. group B were: IL-6, 8.54+/-11 vs. 2.71+/-1.9 pg/ml (p=0.000); TNF-alpha, 14.33+/-24 vs. 5.12+/-15 pg/ml (p=0.016); sTNFR60, 3.9+/-2.8 vs. 2.36+/-1.4 ng/ml (p=0.000); and sTNFR80, 11.9+/-7 vs. 9.4+/-6 ng/ml (p=0.080). The mean serum cytokine levels in group A vs. group C were: IL-6, 8.54+/-11 vs. 4.74+/-7 pg/ml (p=0.017); TNF-alpha, 14.33+/-24 vs. 5.94+/-3.4 pg/ml (p=0.003); sTNFR60, 3.9+/-2.8 vs. 2.54+/-1.4 ng/ml (p=0.000); and sTNFR80, 11.9+/-7 vs. 10.85+/-8 ng/ml (p=0.470). A positive association between waist circumference and IL-6 (r=0.165, p=0.030) and sTNFR-60 (r=0.276, p=0.000) was detected. A significant correlation coefficient was observed between haemoglobin A1c (HbA1c) and both IL-6 (r=0.278, p=0.000) and sTNFR-60 (r=0.293, p=0.000), when the groups were studied as one. No correlation between inflammation and units of insulin/kg BW was found. In conclusion, low-grade chronic inflammation, as estimated by the relative levels of inflammatory cytokines, was present in patients with type 2 diabetes that were receiving insulin treatment, with significantly higher cytokine levels recorded compared to sulfonylurea-treated patients. In addition, an association between inflammation and both obesity and glucose homeostasis was detected.
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Intrauterine fistulation of perforated Meckel's diverticulum to the surface of the sac of an intact exomphalos minor. Minerva Pediatr 2008; 60:253-254. [PMID: 18449142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The presence of Meckel's diverticulum in the exomphalos sac is a well known entity but the intrauterine perforation of the diverticulum is very rare. We report a case of intrauterine fistulation of Meckel's diverticulum to the surface of the intact sac of an exomphalos minor.
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Abstract
PURPOSE Hydatidosis is a serious problem in non-endemic countries due to the influx of immigrants from nations where preventive measures are inadequate. The aim of this retrospective study is to present our experience in the management of hydatidosis in children and to define the criteria for the most effective model of treatment. MATERIAL AND METHODS Over a 21-year period (1985 - 2006), 150 children with pulmonary and abdominal hydatidosis (ECHINOCOCCUS CYSTICUS) were treated at our department. The anatomical location of the parasite was as follows: liver 82, lungs 59, spleen 4, mesentery 2, kidneys 2 and pelvic floor 1 case. Medical treatment with oral antihelminthic agents was given to 37 patients (45.1 %), with liver hydatidosis, 36 patients (61 %) with pulmonary hydatidosis and one patient with hydatid cyst of the spleen. The remaining 76 patients were submitted primarily to excision of the cyst or partial capsectomy. RESULTS Medical treatment was ineffective in 16 patients (43.2 %) with liver hydatidosis, 11 patients (30.6 %) with pulmonary hydatidosis and one patient with hydatidosis of the spleen. All patients with pulmonary hydatidosis who failed to respond to medical treatment developed complications requiring surgical intervention. Of the 76 patients who were submitted to surgery initially, only 4 (5.3 %) presented with postoperative complications requiring reoperation. In all cases who responded inadequately to medical treatment or developed complications the cyst diameter exceeded 6 cm. The overall long-term results were good. CONCLUSIONS a) Hydatid cysts with sizes exceeding 6 cm in diameter should not be treated medically; b) medical treatment seems to be more effective for pulmonary hydatidosis but failed medical treatment in these patients leads to complications with increased morbidity; c) large hydatid cysts should be treated surgically from the start.
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Amyand's hernia in premature neonates: report of two cases. Hernia 2007; 11:547-9. [PMID: 17541492 DOI: 10.1007/s10029-007-0242-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
The finding of a normal or inflamed vermiform appendix within an inguinal hernia is termed Amyand's hernia. It is extremely rare in children, especially in infants and neonates. When it occurs, it is usually misdiagnosed as an irreducible or strangulated inguinal hernia, and the accurate diagnosis is made intraoperatively. We report two cases of Amyand's hernia in premature neonates. Both patients presented on admission with signs and symptoms indicating a strangulated right inguinal hernia, and the accurate diagnosis was made intraoperatively. One of them had progressed to local peritonitis. Appendicectomy and hernia repair were made at the same time through an inguinal transverse incision, and the postoperative course was uneventful in both. We point out the need to consider acute appendicitis in the differential diagnosis of strangulated right inguinal hernia.
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Ankle-brachial index: a surrogate marker of microvascular complications in type 2 diabetes mellitus? INT ANGIOL 2007; 26:253-7. [PMID: 17622207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM The aim of this study was to investigate the potential role of ankle-brachial index (ABI) as a marker of microvascular disease in patients with type 2 diabetes mellitus. METHODS This study included 126 type 2 diabetic patients (64 male and 62 female) with an age of 66.6+/-5.3 years (mean+/-SD) and diabetes duration of 13.2+/-4.1 years. ABI was measured with a Doppler device. The exclusion criterion was the medial arterial calcification. Patients were also examined for microalbuminuria, retinopathy and peripheral neuropathy. RESULTS ABI was significantly lower in patients with microalbuminuria than in those without microalbuminuria (0.91+/-0.17 vs 1.05+/-0.13, P=0.004), in patients with retinopathy than in those without retinopathy (0.91+/-0.18 vs 1.06+/-0.1, P=0.005), as well as in patients with neuropathy than in those without neuropathy (0.94+/-0.17 vs 1.06+/-0.11, P=0.001). Sensitivity and specificity of ABI <0.9 were 48.8% and 87.9% respectively for microalbuminuria, 39.1% and 93% respectively for retinopathy and 47% and 90.7% respectively for neuropathy. In multiple regression analysis, significant predictor of microalbuminuria was diabetes duration (P=0.0014), significant predictor of retinopathy was diabetes duration (P=0.001), while significant predictors of neuropathy were diabetes duration (P=0.001), male sex (P=0.001) and presence of retinopathy (P=0.047). CONCLUSION ABI is significantly lower in patients with than in those without microvascular complications of type 2 diabetes. An ABI <0.9 has a low to modest sensitivity, but a high specificity for the diagnosis of these complications. Our results suggest a potential role for ABI as a surrogate marker of microvascular complications in type 2 diabetic patients.
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Aortic arch calcification predicts the extent of coronary atherosclerosis in patients with or without type 2 diabetes: short communication. Acta Clin Belg 2007; 62:52-5. [PMID: 17451146 DOI: 10.1179/acb.2007.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIM OF THE STUDY The aim of this study was to evaluate the sensitivity and specificity of aortic arch calcification for detection of severe coronary atherosclerosis in patients suffering from coronary artery disease (CAD), with or without type 2 diabetes. PATIENTS AND METHODS This study included 107 type 2 diabetic patients (68 men) with a mean age of 62.4 +/- 10.7 years and a mean diabetes duration of 14.2 +/- 5.9 years and 104 patients (63 men) with a mean age of 64.5 +/- 9.3 years who did not have diabetes. All patients had CAD, documented by coronary arteriography. Severe CAD was defined as atherosclerosis of the left main branch or atherosclerosis of three coronary arteries or atherosclerosis of the proximal part of the left anterior descending artery. Aortic arch calcification was assessed by means of posteroanterior chest X-rays, studied by a radiologist kept blind to the result of coronary arteriography. RESULTS In type 2 diabetic patients, diagnosis of aortic arch calcification had 65.6% sensitivity and 86.9% specificity for detection of severe CAD. In patients without diabetes, diagnosis of aortic arch calcification had 47.7% sensitivity and 96.7% specificity for detection of severe CAD. CONCLUSIONS Aortic arch calcification has a high specificity for detection of severe coronary atherosclerosis in patients with CAD. Sensitivity is higher in patients with type 2 diabetes, while specificity is slightly higher in non-diabetic patients.
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Abstract
BACKGROUND Intraabdominal desmoplastic small round cell tumors (IDSRCT) are rare in children and predominantly affect male adolescents and young adults. We present our experience in the management of five children with diffuse IDSRCT, managed with aggressive chemotherapy, surgery, radiotherapy and peripheral blood stem cell transplantation. MATERIAL AND METHODS During the last decade five patients, four males and one female (mean age 9.6 years), with diffuse IDSRCT were managed in our department. The main symptoms were abdominal distention, vague abdominal pain, and vomiting. Three patients with inoperable tumor on admission were submitted initially to open biopsy followed by aggressive chemotherapy. Regression of the tumor was followed by a second laparotomy and radical excision of any macroscopically distinguishable masses, followed by chemotherapy. In the remaining two patients a debulking procedure was done initially, followed by chemotherapy. The accurate diagnosis of the disease was established by immunohistochemistry, additionally confirmed in the last two patients by molecular analysis. RESULTS Three patients who had radical excision of the tumor and adjuvant chemotherapy had recurrence after two to six months. In the remaining two patients, recurrence was evident after two and eighteen months, respectively, following debulking. In addition, one patient with recurrence received radiotherapy and two others underwent peripheral blood stem cell transplantation. All but one patient died within three years from diagnosis. The last patient, who was submitted to a debulking procedure, is still alive eight months after the operation. CONCLUSIONS Intrabdominal desmoplastic small round cell tumor is a highly aggressive malignancy with a very poor prognosis. Multiagent chemotherapy usually leads initially to a temporary regression of the tumor, but recurrence is the rule. Radical surgical excision, radiotherapy and peripheral blood stem cell transplantation does not seem to improve prognosis significantly. Despite all therapeutic modalities the outcome is dismal and surgical efforts can be considered only as palliative.
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Severity of liver echogenicity is correlated to serum c-peptide levels in type 2 diabetic patients. Acta Clin Belg 2006; 61:5-9. [PMID: 16673610 DOI: 10.1179/acb.2006.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIM To investigate the correlation between liver echogenicity and serum C-peptide levels in type 2 diabetic patients treated with oral hypoglycaemic agents. PATIENTS AND METHODS The study included 231 type 2 diabetic patients (114 men) with a mean age of 64.3 +/- 6.9 years and a mean diabetes duration of 8.5 +/- 3.2 years. Liver echogenicity was graded by ultrasound examination as follows: Grade 0 (normal liver texture), grade 1 (slight increase of liver echogenicity), grade 2 (moderate increase of liver echogenicity with impaired visualization of intrahepatic vessels and right hemi-diaphragm), grade 3 (marked increase of liver echogenicity with very poor visualization or non-visualization of intrahepatic vessels and right hemi-diaphragm). Serum C-peptide was measured both in fasting state (Fasting C-peptide, FCP) and after glucagon administration (Glucagon-stimulated C-peptide, GCP). RESULTS FCP (median; interquartile range) showed a significant difference (p=0.041) between patients with grade 0 (1.9 ng/dl; 1.1-2.7 ng/dl),grade 1 (2.7 ng/dl; 1.9-3.7 ng/dl), grade 2 (4.1 ng/dl; 2.6-5.1 ng/dl) and grade 3 (6.2 ng/dl; 4.6-7.5 ng/dl) liver echogenicity. GCP (median; interquartile range) also differed significantly (p=0.04) between patients with grade 0 (2.6 ng/dl; 1.8-3.3 ng/dl), grade 1 (4.3 ng/dl; 3.3-5 ng/dl), grade 2 (5.8 ng/dl; 4.6-6.9 ng/dl) and grade 3 (8.3 ng/dl; 6.6-9.5 ng/dl) liver echogenicity. In multiple regression analysis, both FCP and GCP showed significant (p < 0.05) positive correlations with waist circumference, triglycerides, WHR and liver echogenicity. CONCLUSIONS In type 2 diabetic patients treated with oral hypoglycaemic agents, liver echogenicity shows a significant positive correlation with serum C-peptide levels, both in fasting state and after glucagon administration.
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Abstract
Currarino triad is a rare hereditary disease. The complete form is characterized by the presence of an anorectal malformation, usually anorectal stenosis, a presacral mass and sacral bony defect. The main symptom is the presence of constipation since early life. In over 80 % of cases, the syndrome is diagnosed during the first decade of life. We report on three patients, members of the same family, with the complete form of the syndrome. The main symptom in our patients was intense constipation and the common clinical finding was an ectopic and stenotic anus. In two of them, father and son, the presacral masses were not diagnosed at the time of previous unsuccessful operations in another hospital for correction of the ectopic anus. In the third patient, Currarino syndrome was associated with Hirschsprung's disease. This has not been described previously. Two of the three patients who were admitted in our institution for simultaneous excision of the presacral mass and correction of the anorectal malformation through a posterior midsagittal coccygo-perineal approach, are free of symptoms. To the authors' knowledge, this is the second report of complete Currarino triad in all affected members of the same family.
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Abstract
AIM OF THE STUDY To evaluate mean platelet volume (MPV) in type 2 diabetic versus non-diabetic patients, as well as to investigate the associations between MPV and diabetic complications. MATERIALS AND METHODS This study included 416 patients divided into two groups. Group A comprised 265 type 2 diabetic patients (131 men) with a mean age of 67.4 +/- 9.5 years and a mean diabetes duration of 14.5 +/- 5.7 years. Group B comprised 151 non-diabetic patients (74 men) with a mean age of 68.6 +/- 9.1 years. MPV (blood samples anticoagulated with sodium citrate) was measured in two blood cell counters (Sysmex SF 3000 and Cell-Dyn 3700). RESULTS MPV was significantly higher (P = 0.01) in group A (14.2 +/- 2.2 fl) than in group B (7.1 +/- 1.2 fl). In group A MPV was significantly higher (P = 0.043) in patients with retinopathy (15.8 +/- 1.3 fl) than in patients without retinopathy (10.9 +/- 1.1 fl) and also significantly higher (P = 0.044) in patients with microalbuminuria (15.6 +/- 1.2 fl) than in patients without microalbuminuria (10.1 +/- 1.2 fl). No association, however, was found in group A between MPV and age, gender, duration of diabetes, insulin dependency, BMI, HbA1c, coronary artery disease or dyslipidaemia. CONCLUSIONS MPV is higher in type 2 diabetic patients than in non-diabetic patients. Among type 2 diabetic patients MPV is higher in those who have microvascular complications (retinopathy or microalbuminuria).
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Rectosigmoid ectasia associated with anorectal anomaly repair: experience with sigmoid anterior resection and endorectal pull-through. Eur J Pediatr Surg 2005; 15:268-72. [PMID: 16163593 DOI: 10.1055/s-2005-865764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Surgical treatment of anorectal anomalies may be followed by severe constipation with or without overflow incontinence secondary to dilation and ectasia of the rectosigmoid. The aim of this study is to evaluate the efficacy of anterior resection and endorectal pull-through for the treatment of rectosigmoid ectasia secondary to posterior sagittal anorectoplasty (PSARP). MATERIAL AND METHOD Seven patients with a history of PSARP presented with serious rectosigmoid ectasia and overflow incontinence of fecal impaction. Four were boys and 3 were girls aged from 16 months to 15 years. Preoperative diagnosis was based on physical examination, barium enema, MRI and rectal biopsy. Surgical treatment of the post-PSARP rectal ectasia was made by anterior resection of the ectatic segment of the sigmoid combined with pull-through of normal colon into the mucosectomized ectatic rectum. RESULTS During a four-to ten-year follow-up period all of our patients had normal bowel movements. Postoperative barium enema radiography demonstrated a normal rectal caliber and manometry revealed normal anorectal motor function. CONCLUSIONS The good postoperative results draw attention to the following. a) The aim of the surgical treatment of megarectum is to establish a neorectum with normal bowel. b) Resection of megasigmoid and pull-through of bowel with normal caliber into the mucosectomized ectatic rectum is an effective procedure in patients with post-PSARP rectosigmoid ectasia. c) The neorectum attains its reservoir function through a gradual process after resection and endorectal pull-through.
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Abstract
Background: The purpose of this study is to evaluate the severity of aortic arch calcification among type 2 diabetic patients in association with diabetes duration, diabetic complications, coronary artery disease and presence of cardiovascular risk factors. Patients and methods: This study included 207 type 2 diabetic patients (101 men) with a mean age of 61.5 ± 8.1 years and a mean diabetes duration of 13.9 ± 6.4 years. Aortic arch calcification was assessed by means of posteroanterior chest X-rays. Severity of calcification was graded as follows: grade 0 (no visible calcification), grade 1 (small spots of calcification or single thin calcification of the aortic knob), grade 2 (one or more areas of thick calcification), grade 3 (circular calcification of the aortic knob). Results: Severity of calcification was grade 0 in 84 patients (40.58%), grade 1 in 64 patients (30.92%), grade 2 in 43 patients (20.77%) and grade 3 in 16 patients (7.73%). In simple regression analysis severity of aortic arch calcification was associated with age (p = 0.032), duration of diabetes (p = 0.026), insulin dependence (p = 0.042) and presence of coronary artery disease (p = 0.039), hypertension (p = 0.019), dyslipidaemia (p = 0.029), retinopathy (p = 0.012) and microalbuminuria (p = 0.01). In multiple regression analysis severity of aortic arch calcification was associated with age (p = 0.04), duration of diabetes (p = 0.032) and presence of hypertension (p = 0.024), dyslipidaemia (p = 0.031) and coronary artery disease (p = 0.04), while the association with retinopathy, microalbuminuria and insulin dependence was no longer significant. Conclusions: Severity of aortic arch calcification is associated with age, diabetes duration, diabetic complications (retinopathy, microalbuminuria), coronary artery disease, insulin dependence, and presence of hypertension and dyslipidaemia.
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Abstract
Pulmonary hydatidosis is more frequently encountered in children than in adults. Chemotherapy with oral administration of particular antihelminthic agents (mebendazole and albendazole) has proved to be effective. This treatment, however, may be associated with serious complications that require surgical management. The aim of this study was to define the limitations of medical treatment, the subsequent complications, and their management. During a 16-year period (1985-2001), 36 children with pulmonary hydatidosis (Echinococcus cysticus) were medically treated. Oral antihelminthic agents (mebendazole until 1992 and albendazole thereafter) were given to all these patients. During this treatment, 11 patients developed complications requiring surgical intervention. In seven children, pleural empyema, or the presence of inflammatory residual fluid, was noted. The remaining four developed pulmonary abscess combined with fluid collection within the pleural cavity. In all complicated cases, the mean size of the cysts exceeded 6 cm in diameter at the beginning of medical treatment. At operation, suturing of communicating bronchi was insecure due to inflammation. Postoperatively, three patients had air leakage from the bronchial tree, requiring continuous suction and prolonged hospitalization. One patient presented with pneumothorax 4 months postoperatively and was operated on again. Overall, long-term results were good. We concluded that a) large pulmonary hydatid cysts should not be treated medically, b) incomplete expectoration of the cyst contents after the parasite death may lead to infection through bronchial communication, and c) patients surgically treated for complications following medical treatment are hospitalized twice as long as patients surgically treated in the first place.
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Evidence that patients at diagnosis of type 2 diabetes mellitus in Northern Greece are increasingly younger and more obese during the last years. Acta Diabetol 2003; 40:1-2. [PMID: 12688251 DOI: 10.1007/s005920300000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Intraabdominal Desmoplastic Small Round Cell Tumour (IDSRCT) is a very rare neoplasia with a unique immunoprofile. Children and young adults are most commonly affected. We report two cases with IDSRCT in children who initially presented with ascites, pain and abdominal mass. Complete surgical excision was possible only in one patient. Although both patients underwent multiagent chemotherapy, they had a relapse of the disease. One patient died two years after diagnosis. The tumour has a very poor prognosis. Survival is correlated to the radical resection of the tumour combined with intense chemotherapy and radiotherapy.
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Gravity of aortic arch calcification as evaluated in adult Greek patients. INT ANGIOL 2002; 21:233-6. [PMID: 12384643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the gravity of aortic arch calcification in adult Greek patients. METHODS A total of 1027 patients (498 men, 529 women) were included. Aortic arch calcification was assessed by means of posteroanterior chest X-rays. These were studied by two radiologists blinded to the patients' medical records. Calcification was graded as follows: grade 0 (no visible calcification), grade 1 (small spots of calcification or single thin calcification of the aortic knob), grade 2 (one or more areas of thick calcification), grade 3 (circular calcification of the aortic knob). All patients were clinically and electrocardiographically examined for coronary artery disease. The other parameters included in the analysis were age, sex, smoking, body-mass index, hypertension, dyslipidemia, diabetes mellitus and history of stroke. RESULTS Calcification gravity was grade 0 in 421 patients (41%), grade 1 in 308 patients (30%), grade 2 in 216 patients (21%) and grade 3 in 82 patients (8%). In simple regression analysis the gravity of aortic arch calcification was positively correlated with age (p=0.01), diabetes mellitus (p=0.014), hypertension (p=0.022), dyslipidemia (p=0.038) and coronary artery disease (p=0.041). In multiple regression analysis it was associated with age (p=0.019), diabetes mellitus (p=0.02) and hypertension (p=0.03). CONCLUSIONS Gravity of aortic arch calcification in adult Greek patients may easily be assessed on routine chest X-rays and is positively correlated with coronary artery disease, as well as important cardiovascular risk factors (age, diabetes mellitus, hypertension and dyslipidemia).
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Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis. Pain 1999; 83:235-41. [PMID: 10534595 DOI: 10.1016/s0304-3959(99)00107-4] [Citation(s) in RCA: 230] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acupuncture has gained increasing attention in the treatment of chronic pain. The lack of a satisfying placebo method has made it impossible to show whether needling is an important part of the method or whether the improvement felt by the patient is due to the therapeutic setting and psychological phenomena. Also, the effectiveness of acupuncture has not been demonstrated sufficiently. We treated 52 sportsmen with rotator cuff tendinitis in a randomised single-blind clinical trial using a new placebo-needle as control. Patients were treated for 4 weeks. The primary endpoint of the trial was the change in the modified Constant-Murley-score from the baseline. Assessment of the treatment outcome was made by experienced orthopaedists not informed of the treatment allocation. Acupuncture with penetration of the skin was shown to be more effective than a similar therapeutic setting with placebo needling in the treatment of pain. The acupuncture-group improved 19.2 Constant-Murley-score points (SD 16.1, range from -13 to 50), the control-group improved 8.37 points (SD 14.56, range from -20 to 41), (P=0.014; C.I. 2.3;19.4). This study showed that needling is an important part of the acupuncture effect in the treatment of chronic shoulder pain in athletes. No conclusions can be derived from this study concerning the importance of choosing points and the rules of Traditional Chinese Medicine. Using the new placebo method as control for other ailments could improve the evidence of specific acupuncture effects beyond pain treatment.
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Abstract
Lung volumes were measured in 45 children with chronic renal failure and compared to 10 healthy controls. Six patients were receiving conservative treatment (CT), 11 were undergoing regular haemodialysis (HD), 8 were on continuous ambulatory peritoneal dialysis (CAPD) and 20 were post transplantation (TP). We measured vital capacity (VC) and forced expiratory volume in 1 s (FEV-1) with a bell spirometer. In addition residual volume (RV) was determined in CAPD patients. VC and FEV-1 values below the lower limit of predicted normal values from healthy children with the same body height were found in 38% and 52% of all patients respectively (P less than 0.05). Median values of VC and FEV-1 were lowest in CT and highest in TP patients. Median FEV-1 was significantly reduced to 79% of predicted values in CT and to 82% in HD patients (P less than 0.05). No correlation was found between FEV-1 and haemoglobin levels or the concomitant use of beta-blocking agents. During a HD session mean FEV-1 increased significantly. In CAPD patients the routine filling of the abdomen was followed by an 11% decrease of RV (non significant) while the other parameters remained stable. It is concluded that lung volumes are frequently reduced in chronic renal failure but remain essentially stable during the dialysis procedures.
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