Abdominal aorta aneurysm endograft infection mimicking bacteraemic urinary tract infection.

BACKGROUND: Endograft infection complicating endovascular aneurysm repairs is infrequent and presents various symptoms and findings, the most common being abdominal pain, fever, fatigue, and gastrointestinal bleeding. DESCRIPTION OF THE CASE: Α 75-year-old male patient with endovascular graft infection presented with a three-day history of fever and was initially misdiagnosed as a bacteremic urinary tract infection. Due to high surgical risk, a drainage tube was placed, and the patient was treated with intravenous antibiotics for three weeks and then with oral antibiotics for two months. On the six-month follow-up, there were no signs of infection recurrence. CONCLUSION: Endovascular graft infections generally require antibiotic therapy combined with surgical debridement and revascularization. This case illustrates a successful alternative management strategy with percutaneous drainage of the aortic sac abscess combined with long-term oral antibiotic therapy. This case also underlines the high index of suspicion necessary for the accurate and timely diagnosis and management of endovascular graft infections. HIPPOKRATIA 2021, 25 (2) 91-93.

Increased cardiovascular and renal disease but not reduced life expectancy among diabetic participants in the general Northern Greek population.

We compared life expectancy and causes of death based on death certificates of 269 diabetic participants (group A) and 5659 nondiabetic participants (group B) who died from January 1, 1991 to December 31, 2010, in 3 small towns of Northern Greece. Age at death was significantly (P = .011) higher in group A (77.2 ± 8.7 years) than in group B (75.7 ± 18.9 years). Males with diabetes lived longer with a mean difference of 4.7 (2.8-6.6) years (P < .001), whereas females without diabetes lived longer, with a mean difference of 2.3 (1.1-5.6) years (P = .004). Diabetic participants died more frequently of myocardial infarction (P = .001), chronic renal failure (P < .001), followed by pneumonia (P = .010) and hyperosmolar non-ketotic coma (P < .001). Nondiabetic participants died more frequently of lung cancer (P < .001), old age (P < .001), and car accidents (P = .004). In conclusion, the cardiovascular and renal disease burden among diabetic participants did not reduce life expectancy, especially in men.

Circulating plasma vascular endothelial growth factor and microvascular complications of type 1 diabetes mellitus: the influence of ACE inhibition.

AIMS: To determine whether circulating plasma vascular endothelial growth factor (VEGF) is elevated in the presence of diabetic microvascular complications, and whether the impact of angiotensin-converting enzyme (ACE) inhibitors on these complications can be accounted for by changes in circulating VEGF. METHODS: Samples (299/354 of those with retinal photographs) from the EUCLID placebo-controlled clinical trial of the ACE inhibitor lisinopril in mainly normoalbuminuric non-hypertensive Type 1 diabetic patients were used. Albumin excretion rate (AER) was measured 6 monthly. Geometric mean VEGF levels by baseline retinopathy status, change in retinopathy over 2 years, and by treatment with lisinopril were calculated. RESULTS: No significant correlation was observed between VEGF at baseline and age, diabetes duration, glycaemic control, blood pressure, smoking, fibrinogen and von Willebrand factor. Mean VEGF concentration at baseline was 11.5 (95% confidence interval 6.0--27.9) pg/ml in those without retinopathy, 12.9 (6.0--38.9) pg/ml in those with non-proliferative retinopathy, and 16.1 (8.1--33.5) pg/ml in those with proliferative retinopathy (P = 0.06 for trend). Baseline VEGF was 15.2 pg/ml in those who progressed by at least one level of retinopathy by 2 years compared to 11.8 pg/ml in those who did not (P = 0.3). VEGF levels were not altered by lisinopril treatment. Results were similar for AER. CONCLUSIONS: Circulating plasma VEGF concentration is not strongly correlated with risk factor status or microvascular disease in Type 1 diabetes, nor is it affected by ACE inhibition. Changes in circulating VEGF cannot account for the beneficial effect of ACE inhibition on retinopathy.

Determinants of exercise-induced ST segment depression in patients with coronary artery disease: a multivariate approach.

The purpose of this study was to delineate among the usually gathered parameters in an electrocardiographic exercise test the determinants of its positive outcome (delta ST decreases > or = 1 mm measured at 80 msec from the J point). The authors studied 832 patients investigated with Bruce's exercise testing and with diagnostic coronary arteriography, all of whom were shown to have significant coronary artery disease (diameter stenosis > or = 50%). Twenty-five demographic, clinical, electrocardiographic, exercise, and anatomic/hemodynamic parameters were analyzed. The stepwise forward logistic regression analysis retained seven among them as significant independent predictors: four as positive contributors: (1) three-vessel and/or left main disease (P = 0.0000), (2) Gensini's angio-graphic score for disease extent (P = 0.0025), (3) anginal pain during the test (P = 0.0000), and (4) age (P = 0.0031) and three as negative contributors: (1) resting heart rate (P = 0.0004), (2) history of old myocardial infarction (P = 0.0019), and (3) pathological Q waves at the resting ECG (P = 0.0018). These findings establish standards that permit the prediction of the positive electrocardiographic exercise outcome in patients with significant coronary disease.

Haemoglobin O Arab in the Pomak population of Thrace.

A 21 year old woman from Thrace with clinical and laboratory findings of mild hemolysis, was found to be homozygous for haemoglobin O Arab. Blood samples from 15 members of her family and from 42 inhabitants of her village were examined for the presence of Hb O Arab. A high incidence of this variant allele was also detected among the patient's family members as well as in other inhabitants of the village (p = 0.274 +/- 0.049). The possibility that Pomaks, a culturally unique tribe with controversial ethnic origin, may represent one of the original pools for the geographic distribution of the gene in the broader area of the Mediterranean basin is discussed.

Epidemiology of diabetes mellitus in the elderly in northern Greece: a population study.

This population based study was undertaken to ascertain the overall prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the elderly using the WHO criteria. The role of obesity in the development of DM or IGT has been investigated for both sexes per decade of age. Furthermore the potential for DM to increase with age, as has been suggested before, has been evaluated using the IGT as a proportion of total glucose intolerance (IGT/TGI) for the same parts of the tested sample. From the 647 persons registered as elderly people in a small town in northern Greece (total population 5875 people), 66 persons did not participate in this survey. Fifty-six subjects (9.7%) had previously diagnosed DM. The remainder were tested using fasting blood glucose measurements or an oral glucose tolerance test (OGTT). The prevalence of previously undiagnosed DM according to fasting blood glucose values or after 2 h of 75 g load values was 10.1% and 9.3%, respectively. Thus the overall prevalence of DM was 29.1% and of IGT was 15.1%. These data support an increased frequency of DM (65% previously undiagnosed) and IGT in the elderly, whereas this population's susceptibility seems to decline in the older groups for both sexes. Obesity remains a risk factor for DM and IGT particularly among the younger groups although its role has been found to decline with age.

Comparison of respiratory response of jogging in place and Bruce treadmill exercise test.

A comparison of the respiratory responses of jogging in place, an alternative exercise test we recently proposed, was made with those of the Bruce exercise test. We obtained on-line measurements of heart rate, ventilation, oxygen uptake, and carbon dioxide production from 9 healthy subjects of mean age 25 years. There was a higher heart rate and ventilatory response with jogging than with the Bruce test, but by 10 minutes the responses of the two tests were similar. Oxygen consumption, while higher with jogging, rose in parallel with that of the Bruce test from the second to the seventh min, and the change of the ratio of minute ventilation to oxygen consumption indicated that the anaerobic threshold occurred earlier during jogging. These results show that jogging in place is more vigorous than the graded exercise test and may produce ischemia earlier.

Post-exercise response of the systolic blood pressure in the diagnosis of coronary artery disease: comparison of two exercise methods.

We studied 81 angiographically documented coronary artery disease patients and 28 with normal coronary arteries, having paired exercise tests (the Bruce treadmill protocol and the jogging in place test) in order to investigate the value of the ratio of recovery systolic blood pressure to peak exercise systolic blood pressure (postexercise pressure ratio) compared to the classic ST depression. The postexercise pressure ratio was significantly higher in patients with coronary artery disease than in patients with normal coronary arteries for each of the 2 exercise tests (P less than 0.001--P less than 0.00001). On the contrary, we obtained significantly lower sensitivities for the pathologic (greater than mean +/- 2 SD of patients with normal coronary arteries) values of the post-exercise pressure ratio than for the positive electrocardiographic outcome 30% vs 58% (P less than 0.00002) and 37% vs 64% (P less than 0.0001) as well as lower accuracies 48% vs 63% (P less than 0.03) and 52% vs 71% (P less than 0.005), respectively. Thus, we proved that the classic ST depression has much more diagnostic value than the post-exercise pressure ratio and this result is independent of the exercise methodology. Consequently this ratio is not recommended to replace the electrocardiographic exercise criteria.

Jogging in place. Evaluation of a simplified exercise test.

The purpose of this study was to evaluate jogging in place as an electrocardiographic exercise test. Jogging in place continuously recorded via an ordinary single-channel electrocardiograph was compared with the Bruce treadmill protocol with a three-channel monitor and recorder in 141 cases with a wide spectrum of chest complaints. Agreement for the presence or absence of electrocardiographic ischemia (ST-segment displacement greater than or equal to 1 mm at 80 ms from the J point, or U-wave inversion) for the two tests was observed in 91 percent of the cases (95 percent confidence intervals: 86 percent to 95.5 percent). One hundred of the previous cases with paired electrocardiographic exercise tests were compared with the presence of reversible defects on exercise myocardial thallium-201 scintigraphy. The electrocardiographic ischemia had a similar correct classification rate in both methods (83 percent with jogging in place and 85 percent with Bruce treadmill protocol; not significant) against the finding of scintigraphic ischemia. This was also true for 52 cases having selective coronary arteriography. The correct classification rate was 54 percent (28/52) with jogging in place and 48 percent (25/52) with Bruce treadmill protocol (not significant). Given the safety and the easy applicability, even in older persons, this simplified test can be recommended as a valid alternative to the established multistage exercise tests.

[Number of basophils and triglyceride levels in patients with gout]. / Basophilenzahl und Triglyzeridspiegel bei Gichtkranken.

Comparing a group of gouty patients with age and sex matched group of patients in a general medical ward without history of arthritis, we failed to confirm and increase in the absolute or relative basophil count. Total white cell count and packed cell volume were similar in both groups of patients. However, fasting serum triglyceride and serum uric acid were increased, as expected, in the gouty group.

Electrocardiographic criteria of left ventricular hypertrophy in left bundle-branch block.

In order to determine whether the electrocardiographic criteria of left ventricular hypertrophy apply in the presence of left bundle-branch block we studied 79 cases of intermittent left bundle-branch block and compared the QRS voltage and axis before and after its onset. Cases of incomplete left bundle-branch block were excluded. There was a statistically significant correlation between pre- and post-left bundle-branch block values of R or S wave voltage in leads I, V1, V2, V5, and V6, the Sokolow index (R V5 or V6 + S V1), and the QRS axis. There was a statistically significant reduction in R wave voltage in leads I, V5, and V6, an increase in S wave voltage in V1 and V2, and leftward shift of QRS axis, but the Sokolow index remained unchanged, after the onset of left bundle-branch block. The Sokolow criteria for left ventricular hypertrophy apply satisfactorily even in the presence of left bundle-branch block, though specificity is low, but QRS axis is unhelpful.