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ABSTRACT: We describe a case of severe acute aortic regurgitation in a 60-year-old woman due to spontaneous avulsion of an aortic valve commissure. She presented with spontaneous bleeding and a platelet count of 4 000/microl caused by idiopathic thrombocytopenic purpura and developed acute heart failure and respiratory insufficiency. Preoperative transesophageal echocardiography was not diagnostic for the exact mechanism of aortic regurgitation. She received a 2-day course of intravenous immunoglobulin (0.5 mg/kg/d) to increase platelet count. At operation detachment (avulsion) of the commissure between the left and the right coronary cusp was evident. Aortic valve repair was performed with resuspension of the commissure. The postoperative course was uneventful. During a 24-month follow-up period, the patient has remained in NYHA class I.
The Thoracic and Cardiovascular Surgeon 02/2010; 58(1):43-4. · 0.88 Impact Factor
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ABSTRACT: Exercise is known to be a powerful stimulus for the endocrine system. The hormonal response to exercise is dependent on several factors including the intensity, duration, mode of exercise (endurance versus resistance), and training status of the subject. The aim of the present study was to determine the steroid hormonal response (immediately after a race and 1 week later) to endurance exercise under the real conditions of the classic Athens marathon in a group of well-trained, middle-aged, non-elite athletes.
Blood samples were drawn 1 week before the race, directly after completion of the race, and 1 week later.
Serum cortisol and prolactin showed distinct rises 1 h after the race and returned to baseline 1 week later. Androstenedione and dehydroepiandrosterone sulphate did not show any changes. Total testosterone as well as free testosterone dropped significantly 1 h after the race but returned to baseline 1 week later.
In this particular group of non-elite, middle-aged marathon runners, the race resulted in an acute increase in serum cortisol and prolactin levels and in a concomitant decline in testosterone level. The aforementioned changes returned to baseline 1 week later.
European Journal of Internal Medicine 01/2009; 19(8):598-601. · 2.00 Impact Factor
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ABSTRACT: The aim of this work was to study whether chronic obstructive pulmonary disease (COPD) subjects exhibited periodic limb movement (PLMs) during sleep. A retrospective case control study was conducted in the referral sleep disorders laboratory in the University of Patras in southwest Greece. A sample of 23 COPD subjects was compared with 14 severe obstructive sleep apnea (OSA) subjects and 18 periodic limb movement disorder (PLMD) subjects. The PLM Index (PLMI) and PLMs Arousal Index (PLMAI) in COPD subjects differ (p<0.05) from severe OSA patients. The PLMAI differ (p < 0.05) between COPD and PLMD subjects. Spearman's correlation showed a positive statistical significant correlation between PLMI and PLMAI in the entire population and in COPD subjects. There was no statistical significant correlation between sleep-related symptoms and the occurrence of PLMs disorder in COPD patients. In our study, PLMs with associated arousals are often seen in COPD subjects. Further prospective studies will be necessary to clarify the mechanisms whereby the reduction in PLMs in COPD patients improved their sleep and quality of life.
Sleep And Breathing 06/2008; 12(2):155-9. · 1.84 Impact Factor
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ABSTRACT: The aim of this study was to investigate the ability of adult human bone marrow mesenchymal stem cells to differentiate towards a cardiomyogenic phenotype IN VITRO.
Bone marrow samples were aspirated from 30 patients undergoing open heart surgery from the anterior iliac crest. Second passaged cells were treated with 10 microM 5-azacytidine. As control groups we used cells not expanded in culture and cells untreated with 5-azacytidine. Morphologic characteristics were analysed by confocal and electron microscopy. The expression of the cytoskeletal protein vimentin and muscle-specific myocin heavy chain was analysed by immunohistochemistry. The expression of the cardiomyocyte specific genes alpha-cardiac actin, beta-myocin heavy chain and cardiac troponin-T was detected by reverse transcriptase polymerase chain reaction.
Mesenchymal stem cells were spindle-shaped with irregular processes. Cells treated with 5-azacytidine assumed a stick-like morphology. They connected with adjoining cells to form myotube-like structures. Numerous myofilaments were detected in induced cells which were immunohistochemically positive for myosin heavy chain and vimentin. The mRNAs of all specific cardiac genes were expressed in both induced and uninduced cells.
These results indicate that adult human bone marrow mesenchymal stem cells treated with 5-aza can differentiate towards a cardiomyogenic lineage IN VITRO.
The Thoracic and Cardiovascular Surgeon 04/2008; 56(2):77-82. · 0.88 Impact Factor
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ABSTRACT: Thymic epithelial tumors can cause venous obstruction from compression or direct invasion of the superior vena cava (SVC) or the innominate veins. We report a case of a 40-year-old patient with a Masaoka stage III thymoma that resulted in obstruction of the left innominate vein and extrinsic compression of the SVC. All macroscopic tumors were resected together with ligation of the left innominate vein and reconstruction of the SVC with an ePTFE graft. Early graft thrombosis occurred in the first postoperative month with clinical signs of SVC syndrome. Endovascular repair was performed with the deployment of self-expanding nitinol stents, resulting in immediate relief of symptoms. The stented graft has remained patent for a follow-up period of 7 months.
The Thoracic and Cardiovascular Surgeon 07/2007; 55(4):267-70. · 0.88 Impact Factor
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ABSTRACT: This report describes a female patient with bronchiectasis, presented to our department with recurrent hemoptysis. Bronchoscopy revealed nothing else but blood arising from the upper lobe bronchus. High resolution computing tomography of the lung (HRCT) revealed bronchiectasis of the upper lobe. A right upper lobectomy was performed. Behind bronchiectasis multiple nodular lesions, 5-10 mm were observed. Histological and immunohistochemical examination revealed findings consistent with peripheral typical bronchial carcinoids.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 07/2006; 65(2):110-3.
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ABSTRACT: Cardiac allograft vasculopathy (CAV), a form of accelerated atherosclerosis, is the major cause of late death in heart transplant recipients. Routine annual coronary angiography has been used as the standard surveillance technique for CAV in most transplant centers.
The aim of this study was to investigate the clinical utility of routine angiographic surveillance in the detection and management of CAV in transplant recipients.
We reviewed the case notes and angiograms of 230 patients who underwent cardiac transplantation in our unit between January 1986 and January 1996 and survived beyond the first year post transplantation.
Significant complications secondary to angiography arose in 19 patients (8.2%). Cardiac allograft vasculopathy was present on none of angiograms performed 3 weeks post transplantation, but was identified in 9 patients (4%) at the first annual angiogram and an additional 25 patients by the fifth annual angiogram. A target lesion suitable for angioplasty was only identified in two patients, and only limited procedural success was achieved in both cases. Twenty-five patients (11%) died during the study period, and the most common cause of late death was graft failure which occurred in 10 patients. All patients who died from graft failure had significant CAV at autopsy, but the most recent coronary angiogram had been normal in eight of these patients.
These data clearly illustrate the limited clinical utility of routine angiographic surveillance for CAV in heart transplant recipients and prompted us to abandon this method of surveillance in our unit.
Clinical Cardiology 07/2001; 24(6):459-62. · 2.15 Impact Factor
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ABSTRACT: Tele-medicine sub-services backed up by a novel, open-architecture Tele-Working platform, are evaluated. This multimedia platform, developed over the Hellenic integrated services digital network (ISDN), is based on user terminals (personal computers), networking apparatus, and a central database. The developed product equips the Hellenic PTT Organization (OTE) with a ready-to-be applied novel service that would supply future subscribers (MDs) the means to remotely collaborate in real time, exchange data on- and off-line, enhance their diagnoses, electronically fix, accept, or modify patient visits, 'build' virtual rooms to meet, etc. The platform, especially focused to implement a tele-medicine system, was tested for a period of over nine (9) months through a network of twenty-two (22) nodes situated in remote counties of Hellas.
Engineering in Medicine and Biology Society, 2001. Proceedings of the 23rd Annual International Conference of the IEEE; 02/2001
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K Spiropoulos, N Charokopos,
T Petsas,
G Trakada,
D Dougenis,
A Mazarakis,
J Christodoulou,
A Peristerakis,
P Ginopoulos,
N Mastronikolis,
D Alexopoulos
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ABSTRACT: The feasibility and reliability of the combination of several noninvasive methods using a multivariate method of analysis to predict pulmonary artery hypertension (PAH) is evaluated in 20 patients with chronic obstructive pulmonary disease. These methods comprised arterial blood gases (Pao2, Paco2), pulmonary functional parameters (FEV1), echo-Doppler parameters (tricuspid regurgitation jets, acceleration time on pulmonary valve), computed tomography measurements (transhilar distance, hilar thoracic index, and measurement of the descending branch of the right pulmonary artery to the lower lobe). A multiple stepwise regression analysis (including one Doppler parameter, two parameters of arterial blood gases, and one functional parameter) revealed a coefficient of determination (R2) equal to 0.954 for mean pulmonary artery pressure (MPAP) with a standard error of estimate (S.E.E.) of 5.25 mmHg. A stepwise regression analysis including computed tomography and radiographic parameters revealed an R2 equal to 0.970 for PAP with a S.E.E. of 4.26 mmHg. Logistical regression analysis classified correctly 80% of patients with PAH using noninvasive methods such as the diameter of the main pulmonary artery and the diameter of the left pulmonary arterial branch calculated by computed tomography. Not only the presence of PAH but also the level of MPAP can be estimated by the combination of multiple stepwise and logistical regression analyses.
Beiträge zur Klinik der Tuberkulose 02/1999; 177(2):65-75. · 1.90 Impact Factor
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ABSTRACT: A powerful formation of artificial neural networks (ANNs) for
implementing a medical decision making system (MDMS) in the field of the
entire spectrum of pulmonary diseases (PDs), is the topic treated in
this article. These ANNs were taught by means of real-world medical data
patterns given by a team of PDs medical experts. Preliminary and more
elaborate experiments showed an overall accuracy of about 92% in the
MDMS' generalization results, a very promising achievement considering
the complexity of the task
Systems, Man, and Cybernetics, 1994. 'Humans, Information and Technology'., 1994 IEEE International Conference on; 11/1994
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ABSTRACT: An original medical expert system (MES) in the field of pulmonary
diseases (PDs), is the topic of this article. This MES covers the full
spectrum of PDs, being the first that attempts to treat a whole category
of distressed body organs. It is based on a first presented composition
of powerful artificial neural networks (ANNs) that have been taught by
means of real patients' clinical data,. The proposed MES exhibits an
overall performance of at least 85% in its generalization results
Neural Networks for Signal Processing [1994] IV. Proceedings of the 1994 IEEE Workshop; 10/1994
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ABSTRACT: The aim of the study was to examine the quality of the characteristics of Erectile Dysfunction (ED) in men with Obstructive Sleep Apnea Syndrome (OSAS) and to investigate whether there is an improvement with the use of continuous positive airway pressure (CPAP) therapy.
Fifteen men with OSAS and sexual dysfunction have been investigated in this follow-up study. The treatment period was for 12 weeks and the therapeutic CPAP levels were determined during the full night of the therapeutic titration.
In our 15 treated patients, the International Index Erectile Function (IIEF) total and all domain scores had increased after the CPAP treatment compared to the baseline, except for that of sexual desire domain.
CPAP therapy can improve the sexual function in ED patients with OSAS.
La Clinica terapeutica 158(6):515-8. · 0.27 Impact Factor
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ABSTRACT: Endometriosis is a common cause of chronic pelvic pain and infertility affecting women of reproductive age, but the disease in rare conditions may be extragenital so may be present with a variety of symptoms. This is a report of an unusual case of pelvic endometriosis that presented with a recurrent hemothorax.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 61(3):177-9.
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ABSTRACT: The aim of this work was to study whether social factors are risk factors for obstructive sleep apnea (OSA). A second objective was to investigate gender differences in relation to referral to a sleep laboratory for sleep-related breathing symptoms.
A retrospective cross-sectional study was conducted in the referral sleep disorders laboratory in the tertiary University Hospital in Patras in southwest Greece. A sample of 362 subjects originated from this geographic region was screened for social characteristics, i.e., marital status, occupation, and education.
The apnea hypopnea index (AHI) was approximately three times as high in men as in women (p < 0.05). Snoring was reported to be a symptom by 76.6% of males and 75% of females. Excessive daytime sleepiness (EDS) was reported by 25.5% of males and 15% of females. Arousals during sleep were reported by 5.7% of men and 10% of women. The ratio of subjects with concomitant disorders or symptoms did not differ between sexes (p > 0.05). The influence of age, body mass index (BMI), gender, smoking, and social characteristics on AHI was examined by multinomial logistic regression. The following factors remained independent risk factors for the presence of moderate to severe OSA (i.e., AHI > 15/h compared with AHI < 5): (1) Gender: the odds ratio (OR) of males to females was 6.23 (CI = 1.89-20.5). (2) Obesity: the OR of subjects with BMI >30.5 kg/m(2) in comparison to those with lower BMI was 3.83 (CI = 1.86-7.86). (3) Marital status: The OR of married subjects to singles was 2.30 (CI = 1.01-5.32). (4) Occupational status: The OR of subjects outside the work force was 3.85 (CI = 1.16-12.74) and that of the self-employed was 1.70 (CI = 0.70-4.10) compared to a reference group of clerks/employees.
In our study factors associated with the presence of sleep apnea include gender (men), obesity, marriage, and self-employment or being outside the work force.
Beiträge zur Klinik der Tuberkulose 185(4):235-40. · 1.90 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the significance of albumin in bronchial washing fluid (BWF) and its relationship to three tumor markers (CEA, CA 19-9 and NSE).
Serum and BWF samples were collected in a group of 60 patients. Albumin and tumor markers in the BWF and serum of three groups: a control group (CG), a chronic bronchitis group (CBG) and a lung cancer group (CaG), were analyzed in a prospective cross-sectional study. The diagnostic yields of the tests in each environment (serum and BWF) were evaluated by using as cutoff points the values of the corresponding 90th percentile of CG and CBG taken together.
A significant difference in albumin level (p < 0.001) was noted in the BWF of patients with cancer compared with the other two groups. In addition, a significant difference in CEA level (p < 0.001) was observed in the serum of cancer patients compared with the other two groups. The cutoff values for CEA in serum and albumin in BWF were 2.20 ng/mL and 2.00 g/dL, respectively. The areas under the corresponding ROC curves were 93% and 97%. Combination of CEA-serum and albumin-BWF by logistic regression analysis increased their diagnostic value.
Measurement of albumin levels in BWF could be a useful additional diagnostic tool to differentiate malignant from non-malignant lung diseases. Moreover, the combined measurement of CEA in serum and albumin in BWF could be of aid in the follow-up of lung cancer patients.
The International journal of biological markers 19(4):316-21. · 1.48 Impact Factor
