Femoral artery pseudoaneurysms in intravenous drug users: a 12-year series.

AIM: Management of pseudoaneurysms in intravenous drug users poses many questions regarding need for revascularization and type of surgery. The aim of this study was to report on the frequency and management of femoral artery pseudoaneurysms in our department during the last twelve years. METHODS: Retrospective report on patients hospitalized in the Department of Vascular Surgery in Red Cross Hospital, Athens, Greece between January 1999 and May 2010 with femoral artery pseudoaneurysms due to intravenous drug abuse. RESULTS: Overall, 23 patients (18 men, 5 women, mean age 36 years) were identified. Of these, 20 patients underwent revascularization, while femoral artery ligation had to be performed in 3. Intraoperative evaluation of leg perfusion was decisive in choice of treatment. No patient presented with critical limb ischemia postoperatively. No amputations or complications were noted during the follow-up. CONCLUSION: Treatment of common femoral artery pseudoaneurysms in drug abusers should be tailored to individual requirements. Bypass surgery is not always required, due to the pre-existing collateral network in many cases.

Carotid endarterectomy in patients with foetal-type posterior circle of Willis: is there an indication for local anaesthesia?

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

Increased serum levels of uric acid are associated with sudomotor dysfunction in subjects with type 2 diabetes mellitus.

The aim of this paper was to assess serum uric acid (SUA) levels in patients with type 2 diabetes mellitus (T2DM) with or without sudomotor dysfunction (evaluated by the Neuropad test). We included 36 T2DM patients with sudomotor dysfunction (group A: mean age 63.1 ± 2.6 years) and 40 age-, gender-, renal function- and T2DM duration-matched patients without sudomotor dysfunction (group B: mean age 62.1 ± 3.1 years). SUA was significantly higher in group A (P < 0.001). There was a significant correlation between SUA and Neuropad time to colour change in both groups (group A: r(s) = 0.819, P < 0.001; group B: r(s) = 0.774, P < 0.001). There was also a significant positive correlation between SUA and CRP in both groups (group A: r(s) = 0.947, P < 0.001; group B: r(s) = 0.848, P < 0.001). In conclusion, SUA levels were higher in T2DM patients with sudomotor dysfunction than those without this complication. The potential role of SUA in sudomotor dysfunction merits further study.

A prospective study on the use of the indicator test Neuropad® for the early diagnosis of peripheral neuropathy in type 2 diabetes.

AIM: The aim of this prospective study was to evaluate the contribution of the indicator test for sudomotor function Neuropad® to the early diagnosis of peripheral neuropathy in patients with type 2 diabetes mellitus. Included were 109 type 2 diabetic patients (55 men, mean age 56.15 ± 6.14 years), whose initial clinical examination (Neuropathy Disability Score, NDS) was negative for neuropathy. Patients were first examined between January and June 2004 and re-examined 5 years later by the NDS and Neuropad ®. Initially, 70 patients (64.22%) had normal and 39 (35.78%) patients had abnormal Neuropad® (groups A and B, respectively). NDS was significantly higher in group B on both examinations (p < 0.001). On the second examination, 2 patients (2.86%) in group A and 10 patients (25.64%) in group B had developed neuropathy (p = 0.001). Neuropad® had 83.33% sensitivity and 68.04% specificity for neuropathy. There was a modest but significant agreement (kappa = 0.259, p < 0.001) between Neuropad® and NDS for neuropathy. CONCLUSIONS: Among type 2 diabetic patients with normal NDS, development of neuropathy is significantly more frequent in those with abnormal Neuropad®. These results suggest a potential utility of Neuropad® for the earlier diagnosis of neuropathy in type 2 diabetes.

Matrix metalloproteinase-1 and tissue inhibitor of metalloproteinases-1 levels in severely obese patients: what is the effect of weight loss?

INTRODUCTION: There is increased evidence that circulating levels of matrix metalloproteinases and their tissue inhibitors are altered in obesity and may be implicated in its pathogenesis. This study aimed to compare the serum concentrations of pro-matrix metalloproteinase-1 (pro-MMP-1) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in severely obese patients with or without metabolic syndrome, and to investigate the potential effect of weight loss on their circulating levels. METHODS: A total of 102 severely obese subjects were included in our study. Of these, 61 had no other features of metabolic syndrome, while the rest were 41 age- and sex-matched subjects with severe obesity and metabolic syndrome according to the NCEP-ATP criteria. Fourty-two age and sex-matched healthy lean individuals were used as controls. RESULTS: Severely obese subjects had higher circulating levels of TIMP-1 than the lean ones (120.6 ± 50.6 vs. 89.0 ± 35.2 ng/ml) and obese patients with metabolic syndrome had higher TIMP-1 levels than their metabolically healthy counterparts (134.8 ± 38.4 vs. 111.0 ± 55.62 ng/ml). A positive association was also found between TIMP-1 levels and various anthropometric and metabolic parameters in the obese subjects. Moreover, weight loss of more than 5% resulted in a significant reduction of the TIMP-1 levels in obese subjects, irrespective of the presence or not of metabolic syndrome. No significant differences in pro-MMP-1 concentrations were found between the obese (2.8 ± 2.4 ng/ml) and lean individuals (2.8 ± 0.8 ng/ml). CONCLUSIONS: In conclusion, we demonstrated that increased TIMP-1 serum levels are found in severely obese patients and particularly in these with metabolic syndrome, while weight loss of more than 5% resulted in reduction of TIMP-1 levels.

Changes in the epidemiology of hepatitis B virus infection following the implementation of immunisation programmes in northeastern Greece.

The objective of this study was to investigate changes in the epidemiology of hepatitis B virus infection in the general population and selected groups of immigrants in the region of northeastern Greece over the last decade in relation to the introduction of hepatitis B vaccination programmes. Two population-based seroprevalence surveys were carried out during the years 1992-1994 and 1998-2006. In total, 25,105 individuals were tested for the presence of hepatitis B virus markers: HBsAg, anti-HBs and anti-HBc. Childhood/adolescence immunisation programmes began early in 1994 in selected groups of immigrants and were complemented by the national vaccination programme in 1998. Between 1992-1994 and 1998-2006, the HBsAg carrier rate declined from 5.4% [95% CI: 4.5-5.9] in adults (20-60 years old) and 1.9% [95% CI: 1.6-2.4] in children/adolescents (5-19 years old) of indigenous residents to 3.4% [95% CI: 2.9-3.8] and 0.6% [95% CI: 0.2-1.4] respectively (p<0.05). In spite of a decrease compared with 1992-1994, the percentage of HBsAg carriers was still relatively high in 1998-2006 among the Muslim religious minority group (8.2% [95% CI: 8.0-8.7] in adults and 2% [95% CI: 1.7-2.4] in children/adolescents) and in immigrants from the former Soviet Union (4.3% [95% CI: 3.6-4.7] in adults and 1.1% [95% CI: 0.8-2.4] in children/adolescents) (p<0.05 for both selected groups versus general population). The decline of the prevalence of HBsAg in the general population and selected groups of immigrants in northeastern Greece over the last decade supports the effectiveness of the ongoing immunisation programme although the information on the actual number of cases of acute HBV infection is not available.

Post-thyroidectomy thyroxine replacement dose in patients with or without compensated heart failure: the role of cytokines.

OBJECTIVE: To investigate the potential association between serum inflammatory cytokine levels and post-thyroidectomy thyroxine replacement dose in patients with or without compensated heart failure. PATIENTS AND METHODS: The study included 42 patients (group A: 20 men, mean age of 54.5+/-6.8 years) with NYHA I or II heart failure and 54 patients (group B: 25 men, mean age of 52.9+/-7.1 years) without heart failure. All patients had undergone total thyroidectomy and were euthyroid on a stable thyroxine replacement dose. Serum Interleukin-1b (IL-1b), Tumor Necrosis Factor alpha (TNF-alpha), Interleukin-6 (IL-6), TSH, T3, T4, fT3 and fT4 were measured. RESULTS: Both groups exhibited a significant positive correlation between IL-6 and levothyroxine replacement dosage (group A: r=0.708, p<0.001; group B: r=0.345, p=0.012) and a negative correlation between IL-6 and T3 (group A: r=-0.342, p=0.023, group B: r=-0.294, p=0.035). Significant independent predictors of levothyroxine replacement dosage were IL-6 (p<0.001) and TNF-alpha (p=0.007) in group A (58.3% of dosage variation) and only IL-6 (p=0.012) in group B (10.1% of dosage variation). CONCLUSIONS: In both groups, a significant positive correlation was observed between IL-6 and levothyroxine replacement dosage, but this correlation was stronger in group A. In the same group, there was evidence for a more pronounced influence of cytokines on levothyroxine dosage.

An insertion/deletion polymorphism in the alpha2B adrenoceptor gene is associated with peripheral neuropathy in patients with type 2 diabetes mellitus.

UNLABELLED: Alpha2B adrenoceptor (alpha2B-AR) mediates a variety of functions in humans. An insertion/deletion (I/D) polymorphism of the alpha2B-AR gene located on chromosome 2 has been described. The aim of the present study was to investigate the potential association between alpha2B gene I/D polymorphism and peripheral neuropathy in Greek patients with type 2 diabetes mellitus. The study included 130 patients (70 men) with diabetic neuropathy (group A) and 60 patients (34 men) without diabetic neuropathy (group B). There was no difference in age, gender and diabetes duration between the groups. Diabetic neuropathy was diagnosed by clinical examination using the Diabetic Neuropathy Index (DNI). Genotyping of I/D polymorphism was performed by PCR. Frequency of the D allele was significantly higher (p=0.001) in group A (26.9%) as compared to group B (11.7%). DNI score differed significantly (p=0.001) between the three genotype groups (I/I, I/D, D/D). It was significantly higher (p=0.04) in patients with I/D (3.7+/-1) than in those with I/I (2.5+/-0.9) and significantly higher (p=0.001) in patients with D/D (5.6+/-1.3) than in those with I/D (3.7+/-1). CONCLUSIONS: Patients with neuropathy exhibit a significantly higher frequency of the D allele in comparison to those without neuropathy. Presence of the D allele is also associated with a higher neuropathic score. These results provide evidence for an association of the D allele with both presence and severity of neuropathy in patients with type 2 diabetes mellitus.

An insertion/deletion polymorphism in the alpha2B adrenoceptor gene is associated with age at onset of type 2 diabetes mellitus.

Alpha2B adrenoceptor (alpha2B-AR) mediates a variety of functions, including insulin secretion. An insertion/deletion (I/D) polymorphism of the alpha2B-AR gene located on chromosome 2 has recently been described. The aim of the present study was to examine if there is a difference in the D allele frequency of alpha2B-AR gene between type 2 diabetic patients and controls, as well as to ascertain whether the D allele confers an increased risk for earlier onset of diabetes. This study included 199 type 2 diabetic patients and 204 age- and sex-matched healthy volunteers. Genotyping of I/D polymorphism was performed by PCR. No significant difference in the D allele frequency was observed between the two groups (22.1% vs. 19.1%, p = 0.409). Among type 2 diabetic patients, however, presence of the D allele was associated with significantly younger age at onset of diabetes (51.4+/-8.6 vs. 59.2+/-9.7 years, p < 0.001). Multiple stepwise linear regression identified alpha2B I/D genotype as an independent predictor of age at onset of DMT2, explaining 14.3% of its variance. This result indicates that the D allele may be implicated in impaired glucose metabolism leading to earlier manifestation of diabetes in predisposed subjects.

Natural history of chronic HBV infection: a cohort study with up to 12 years follow-up in North Greece (part of the Interreg I-II/EC-project).

The aim of the study was to assess the long-term outcome of chronic hepatitis B surface antigen (HBsAg) carriers in the general population in North Greece (Thrace), an area with an intermediate endemicity. This was a part of the Interreg I-II EC project. Two hundred sixty three chronic HBsAg+ carriers, median age 34 years (20-65), were evaluated prospectively for a median follow-up of 5 years (2-12). Hepatitis B virus (HBV) markers and ALT were examined every 6 months and serum HBV-DNA every 12 months. Liver biopsy was undertaken at presentation and every 2-4 years. Fourteen of 263 (5.3%) subjects were HBeAg+ and 249/263 (94.7%) HBeAg(-)/anti-HBe+ of whom 48 (19.3%) had elevated ALT, and HBV-DNA levels ranging from 1.4 x 10(5)-4 x 10(7) copies/ml. Inactive carriers (98/195 (50.3%)) had detectable HBV-DNA (median 2.6 x 10(3) range 0.042 x 10(4)-1.9 x 10(4) copies/ml); 4/195 (2%) exhibited HBV reactivation during the observation period (all had HBV-DNA >10(4) copies/ml at presentation). Patients (7/14 (50%) HBeAg+) developed anti-HBe+, annual rate 10%. Subjects (16/195 (8%)) lost HBsAg, all were inactive carriers; 10 developed anti-HBs (annual rate 1%). Liver biopsy was normal or with minimal changes in 92/95 (97%) inactive carriers and remained so at 4 years follow-up. In contrast, 4/48 (8.3%) HBeAg(-)/anti-HBe+ patients with active disease had deterioration of liver histology. In this cohort study: (a) the annual seroconversion rate was 1% for the HBsAg and 10% for the HBeAg, (b) 23.6% of the HBsAg+ carriers had active liver disease and 39% moderate fibrosis at presentation of whom a small proportion deteriorated over the observation period, (c) HBsAg carriers with HBV-DNA level <10(4) copies/ml had persistently normal ALT and unchanged liver histology over the follow-up period of up to 12 years.