Patterns of injuries and motor-vehicle traffic accidents in Athens.

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The 'Asclepeion' of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1,000,000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the 'Asclepeion' of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 - 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at 'Asclepeion' of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.

A novel spleen-preserving laparoscopic technique using radiofrequency ablation in a porcine model.

BACKGROUND: Partial splenectomy is considered to be the optimal management for a variety of diseases. At the same time, laparoscopic procedures are increasingly used because they present certain advantages against their open counterparts. In this study, the safety and efficacy of radiofrequency ablation (RFA) were evaluated in laparoscopic partial splenectomy performed in a pig model. METHODS: Eight domestic pigs were used. Four abdominal trocars were inserted under general anesthesia and the spleen was stabilized with laparoscopic clamps. A RFA needle electrode was inserted transcutaneously, and coagulative necrosis of a zone of the splenic parenchyma between the body and the lower pole was performed. Bloodless sharp division and removal of the lower pole followed. After 0, 7, 30, or 120 days, the animals were killed and examined. RESULTS: Blood loss and operation time were minimal. Mortality and morbidity were zero. No abnormal findings were encountered during the postmortem abdominal exploration. CONCLUSION: This study demonstrates the feasibility, safety, and efficacy of laparoscopic RFA-assisted partial splenectomy. The RFA-assisted laparoscopic partial splenectomy adds a novel technique to the surgeon's armamentarium for the preservation of a part of the spleen.

Hepatoprotective activity of Trianthema portulacastrum L. against paracetamol and thioacetamide intoxication in albino rats.

The ethanolic extract of Trianthema portulacastrum L. (Aizoaceae) showed a significant dose dependent (100 mg, 200 mg/kg p.o. 10x) protective effect against paracetamol and thioacetamide induced hepatotoxicity in albino rats. The degree of protection was measured by using biochemical parameters like serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), alkaline phosphatase (ALP), bilirubin (BRN), and total protein (TP). The plant extract completely prevented the toxic effects of paracetamol (acetaminophen) and thioacetamide on the above serum parameters. A significant hepatoprotective activity of the ethanolic extracts of Trianthema portulacastrum L. was reported.

Torsion of a non-gravid leiomyomatous uterus in a patient with myotonic dystrophy complaining of acute urinary retention: anaesthetic management for total abdominal hysterectomy.

Torsion of a pregnant uterus is rare, but torsion of a non-pregnant uterus is extremely rare. Abdominal pain is the major symptom. Other symptoms include vaginal bleeding, urinary tract symptoms and gastro-intestinal manifestations. We present a case of a 37-year-old white nullipara who presented at the emergency room with acute urinary retention. Medical history revealed that the patient carried the disease of myotonic dystrophy, which was diagnosed two years before. Physical examination revealed a tender, distended bladder, which was easily catheterized, draining 900 ml of clear urine. The abdomen was soft with no muscle guarding or rebound tenderness. A palpable large dense mass occupying the cul-de-sac was found during bimanual examination. Abdominal ultrasound examination revealed a large intramural leiomyoma approximately 10 cm in diameter, in the posterior wall of the uterus, which repelled the bladder. In neurological examination the muscular tone and reflexes were reduced in the lower extremities. Myotonic phenomenon was not found. The patient was thought to suffer from myotonic dystrophy and therefore the possibilities for pulmonary and cardiac complications or malignant hyperthermia had to be kept in mind during the anaesthetic management. The patient underwent an exploratory laparotomy and the uterus was found to have undergone a 60 degrees rotation along the corpus and the cervix uteri transition line. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was perfomed. The intra- and postoperative course of the patient was uneventful. In conclusion, in this patient the uterine pathology (large leiomyoma) in combination with the disease of myotonic dystrophy seemed to be the predisposing factors for the torsion of the non-pregnant uterus. Also, the anaesthetic implications for total abdominal hysterectomy in myotonic dystrophy are discussed and the international literature is reviewed.

Efficacy of epidural anesthesia for retroperitoneoscopic renal biopsy.

Laparoscopic procedures are performed using general anesthesia due to the perceived limitations of regional anesthesia in the upper abdomen and retroperitoneum. We present our initial experience with epidural anesthesia for retroperitoneal laparoscopic renal biopsy.

Fever and evoked potentials in multiple sclerosis.

The somatosensory evoked potentials (SEPs) and visual evoked potentials (VEPs) were studied in 19 patients with multiple sclerosis; 17 controls were studied during fever (38.0 degrees - 39.7 degrees C) and 2-3 days following return to normal temperature. The latencies of components N20 and P114 were measured and specified as abnormal when their value exceeded the standard deviation of the controls by 2.5 times. The corresponding criterion for the evaluation of the amplitude of components N20 and P114 was a reduction in amplitude of more than 50%. In the controls fever did not cause significant changes in evoked potentials. On the other hand, patients with multiple sclerosis showed abnormalities in evoked potentials during fever in a greater number of recordings (26 of SEPs and 33 of VEBs) than after return to normal temperature (19 and 27 respectively). In addition, the average latency of components N20 and P114 was clearly greater in the patients during fever (N20 = 29.5 +/- 5.2 ms and P114 = 143 +/- 18.1 ms) than after return to normal temperature (N20 = 6.6 +/- 3.5 ms and P114 = 134 +/- 16 ms). The amplitude of components N20 and P114 in patients during fever was clearly smaller than after return to normal temperature. These differences were statistically significant. Finally, in two patients, a decrease was found, during fever, in the conduction velocity of the peripheral somatosensory pathway from the median nerve to the wrist at Erb's point.

[Mirror reading and writing]. / K voprosu o zerkal'nom pis'me i chtenii.

The case of a left handed patient, a woman 59 years old, who some days after the onset of a right hemiplegia with slight motoric and sensoric aphasic disorders, presented reverse (en miroir) reading and writing is described. Difficulties in the recognition of the right and left side could be revealed during the examination. No hemianopia was noted but an "unwillingness" to turn the eyes to the right side, without paresis, was noted. This could be, in relation with the disorder of the orientation in the space and the reanimation of primitive phasic functions, the basic mechanism that explains the above described symptom of reverse reading and writing.