Mini-invasive anterior approach in total hip arthroplasty: short-term follow-up.

PURPOSE: To evaluate short-term follow-up of patients treated with total hip arthroplasty through minimally invasive anterior approach. METHODS: Twenty-four patients, surgically treated with this approach from January 2010 to December 2010. We measured the blood loss, the number of transfusions, the time of surgery, the length of hospital stay and intra and postoperative complications. All patients were clinically evaluated by Womac and Harris Hip Score 12 months after surgery. Radiographic views were performed postoperatively and at 1, 3 and 12 months after surgery in order to evaluate component positioning. RESULTS: The mean value of total blood loss was 1050 ml, the number of transfusions after surgery was on average 0.85. The mean time of surgery was 111 minutes. The mean hospital stay was 6.5 days. The radiographic views showed a correct component placement. We didn't encounter any complication and the mean score of Womac and Harris Hip Score was satisfactory in all cases. CONCLUSIONS: Minimally invasive anterior approach provides good short-term results. However, long-term studies are needed to confirm this evaluation.

First Report of Tomato yellow leaf curl virus Infecting Common Bean (Phaseolus vulgaris) in Greece.

Tomato yellow leaf curl is one of the most devastating virus diseases of tomato (Lycopersicon esculentum Mill) crops worldwide. Several whitefly-transmitted viruses are associated with the disease and all are assigned to the genus Begomovirus, family Geminiviridae. In Greece, Tomato yellow leaf curl virus (TYLCV) was first reported to infect greenhouse and open-field tomatoes in 2000 (2). During 2006, a survey was conducted in the southwestern part of Peloponnese (mainland) within the areas of Kyparissia and Filiatra (Perfecture of Messinia) to identify the prevalence and natural hosts of the disease. During this survey, yellow mosaic, severe leaf curling, and leaf crumple symptoms were observed in greenhouse bean plants (Phaseolus vulgaris) that were cultivated together with tomatoes showing typical TYLCV symptoms. In all affected greenhouses, the incidence of the disease ranged from 1 to 5% in beans and 90 to 100% in tomato plants. Both bean and tomato plants were highly infested with Bemisia tabaci (Gennadius) populations and produced unmarketable fruits. Twenty-four symptomatic bean plants were collected from four greenhouses that tested positive by triple-antibody sandwich-ELISA using TYLCV-specific antibodies purchased from NEOGEN, EUROPE, Ltd. DNA was extracted from all infected bean plants, and a 580-bp fragment of the coat protein gene was amplified by PCR using the TY(+)/TY(-) primer pair (1). Amplified fragments were then analyzed by restriction fragment length polymorphism with Ava II cutter enzyme. Two DNA fragments of 277 and 302 bp in agarose gels were produced from all isolates and the restriction pattern corresponded to TYLCV. The amplified DNA from four infected bean plants was cloned and sequenced. All four sequences were 100% identical (EMBL Accession No. AM418398) and showed 99% nucleotide identity to a TYLCV isolate from Italy (EMBL Accession No. DQ144621). To our knowledge, this is the first report of TYLCV infection of P. vulgaris, which is an important commercial crop in Messinia, Greece. Within the last decade, TYLCV has emerged as an important pathogen for several cultivated plants in many regions and different TYLCV variants have been reported to infect P. vulgaris (3). Bean is often used as an intercrop between tomato crops, and thus, infected plants may serve as a potential reservoir for virus survival and spread (4). References: (1) G. P. Accotto et al. Eur. J. Plant Pathol. 106:179, 2000. (2) A. D. Avgelis et al. Plant Dis. 85:678, 2001. (3) J. Morris et al. EPPO Bull. 32:41, 2002. (4) J. Navas-Castillo et al. Plant Dis. 83:29, 1999.

Impedance cardiography derived cardiac output in hemodialysis patients: a study of reproducibility and comparison with echocardiography.

BACKGROUND: Hemodialysis patients experience a variety of hemodynamic abnormalities that contribute to cardiovascular disease mortality which is the leading cause of death in these patients. Impedance cardiography has been utilized in order to monitor cardiac hemodynamics with lower cost and inconvenience, but it has not been appropriately validated in the hemodialysis population. AIM: We repeatedly used impedance cardiography to assess short- (48 hours) and long-term (15 days) reproducibility of cardiac output measurements and we compared baseline impedance cardiography measurements with echocardiographic measurements. PATIENTS AND METHODS: We studied 109 stable hemodialysis patients, aged 59.70 +/- 11.97 years being on hemodialysis for 67.59 +/- 40.15 months, on a non-dialysis day. Cardiac output was obtained with the BioZ impedance cardiography system (Cardiodynamics, San Diego, Ca, USA). Baseline echocardiography was performed using a Hewlett-Packard Sonos 2500 (Andover, Mass., USA). RESULTS: The values of impedance cardiography derived cardiac output were 5.28 +/- 0.79, 5.27 +/- 0.75 and 5.25 +/- 0.74 l/min at baseline (107 patients), 48 hours (107 patients) and 15 days (98 patients) respectively, showing high reproducibility. Bland and Altman analysis estimated that bias at 48 hours and at 15 days were: -0.013 (95% confidence intervals = -0.045 to 0.019) and 0.028, (95% confidence intervals = -0.044 to 0.101), respectively. In addition baseline impedance cardiography derived cardiac output was significantly correlated with the echocardiographic derived cardiac output (r = 0.9, p < 0.0001). CONCLUSION: Impedance cardiography is a simple non invasive technique for cardiac output estimation in hemodialysis patients which has high reproducibility when performed under controlled conditions, and is closely correlated with echocardiographic measurements of cardiac output.

Relation between echinocytosis and erythrocyte calcium content in hemodialyzed uremic patients.

A rise in intracellular calcium concentration in erythrocytes has multiple effects on these cells. The purpose of this study was to determine the changes of calcium content in red blood cells (RBCs) and of echinocyte percentages in uremic patients during hemodialysis sessions. In 30 uremic patients under hemodialysis, the calcium content of RBCs and echinocyte percentages were determined in 3 blood samples collected at 0 min hemodialysis (prehemodialysis), 45 min hemodialysis, and 240 min hemodialysis (end hemodialysis) for a 4 h hemodialysis session. Calcium content of RBCs and echinocytes were also determined in 22 normal subjects (controls). The findings of the present study were that the mean values (+/-SD) of calcium content of RBCs in patients at 0 min hemodialysis, 45 min hemodialysis, and 240 min hemodialysis were 2.00 +/- 1.0, 2.66 +/- 0.87, and 1.62 +/- 0.66 microg/ml respectively and 0.65 +/- 0.07 microg/ml in controls. These values show that the calcium content of RBCs in uremic patients at 0 min hemodialysis, 45 min hemodialysis, and 240 hemodialysis was significantly higher than in controls (p < 0.0001), and that RBC calcium content at 45 min hemodialysis was significantly higher in comparison to that at 0 min hemodialysis (p < 0.001) and to that at 240 min hemodialysis (p < 0.0001), while that at 240 min hemodialysis was significantly lower than at 0 min hemodialysis (p < 0.05). The mean values (+/-SD) of echinocyte percentages in patients at 0 min hemodialysis, 45 min hemodialysis, and 240 hemodialysis were 11.93 +/- 6.18, 17.23 +/- 4.1, and 7.96 +/- 5.67% respectively, and in controls ranged from 0 to 1%. The values in uremic patients show a transient increase of echinocyte percentages at 45 min hemodialysis, which is significant in comparison to that at 0 min hemodialysis (p < 0.001) and to that at 240 min hemodialysis (p < 0.0001). Echinocyte percentages at 240 min hemodialysis were significantly lower to those at 0 min hemodialysis (p < 0.001). Correlation between calcium content of erythrocytes and echinocyte percentages shows a significantly positive relationship at 45 min hemodialysis (r = 0.368, p < 0.05) but no significant relationship at 0 min hemodialysis and 240 min hemodialysis. In conclusion, uremic patients under hemodialysis present with high calcium content in erythrocytes and abnormal erythrocytes like echinocytes. A rapid and transient increase of erythrocyte calcium is also accompanied by transient elevation of echinocytes in the first hour of hemodialysis (45 min hemodialysis), which returns after hemodialysis to lower than prehemodialysis levels.

Changes in erythrocyte calcium and potassium in patients during HD and CAPD.

The purpose of this study was to determine the changes in calcium and potassium content in the red blood cells (RBC) of uremic patients during a hemodialysis (HD) session and a 6/hrs CAPD exchange. RBC calcium and potassium were determined in 20 patients on HD in three blood samples collected at 0'-HD (pre-HD), 45'-HD and 240'-HD (end-HD), in 20 patients on CAPD, in two blood samples, collected at 0' time (pre-inflow) and 120', (solution in peritoneal cavity) during a 6/hrs exchange (4 exchanges / 24 h) and in 20 normal subjects. The mean value (+/-SD) of RBC calcium in controls was 15.6+/-3.75 micromol/L, in hemodialysed patients at 0'-HD, 45'-HD and 240'-HD 51.5+/-8.5, 70.4+/-12.5 and 51.1+/-10 micromol/L respectively and CAPD patients at time 0' and 120 of an exchange 53.6+/-23.4 and 70.6+/-9.2 respectively. These values show that RBC calcium in hemodialysed patients is generally significantly higher (p < 0.0001) than in controls. The value at 45'-HD is also significantly higher (p < 0.0001) than at 0' or 240'-HD. In CAPD patients, at 0' and 120' of a 6/hrs exchange, it is significantly higher (p < 0.0001) than in controls, as is the value at 120' (p < 0.001) in comparison to 0'. The mean value (+/-SD) of RBC potassium at the aforementioned time measurements were 95.9+/-3.34, 92.5+/-4.32 and 93.85+/-3.89 mmol/L respectively for patients on HD, 95+/-3.3 and 94.6+/-5.28 mmol/L respectively for patients on CAPD and 99.1+/-3.70 mmol/L in controls. These values show that RBC potassium of hemodialysed patients is significantly lower in comparison to that of controls (0'-HD: p < 0.01, 45'-HD and 240'-HD: p < 0.001); also the value at 45'-HD and 240'-HD is significantly lower (p < 0.001, p < 0.01 respectively) when compared to that at 0'-HD. In patients on CAPD, at 0' time and 120' during 6/hrs exchange, potassium is significant lower (p < 0.001) in comparison to that of controls. In conclusion, uremic patients present high erythrocyte calcium and low potassium with fluctuation during HD-sessions and CAPD 6/hrs exchange.

Is erythrocyte damage prevented by gardos effect in hemodialyzed uremic patients?

The purpose of this study was to determine the changes of calcium and potassium content in red blood cells (RBC) from uremic patients during a hemodialysis (HD) session. In 17 uremic patients on HD, the calcium and potassium content of RBC was determined in 3 blood samples collected at 0 min-HD (pre-HD), 45 min-HD, and 240 min-HD (end-HD) during a 4 h HD session. The calcium and potassium content of RBC also was determined in 20 normal subjects (controls). The mean values (+/-SD) of RBC calcium content in patients at 0 min-HD, 45 min-HD, and 240 min-HD were 1.95 +/- 0.34, 2.82 +/- 0.50, and 2. 05 +/- 0.4 microg/ml, respectively, and in controls 0.61 +/- 0.14 microg/ml. These values show that the RBC calcium in patients was generally significantly higher (p < 0.0001) in comparison to that of controls. The RBC calcium at 45 min-HD was significantly higher as compared to that at 0 min-HD and at 240 min-HD (p < 0.0001). The mean values (+/-SD) of RBCs' potassium in uremic patients at the previously mentioned measurements were 95.9 +/- 3.34, 92.5 +/- 4.32, and 93.85 +/- 3.89 mEq/L, respectively, and in controls 98.46 +/- 2. 30 mEq/L. These values show that RBC potassium of patients was generally significantly lower in comparison to controls (0 min-HD: p < 0.01, 45 min-HD and 240 min-HD: p < 0.001). Potassium decrease also was significantly lower at 240 min-HD (p < 0.01) and even lower at 45 min-HD (p < 0.001) compared to that at 0 min-HD. In conclusion, uremic patients during an HD session present a high calcium and a low potassium content of erythrocytes. These changes may prevent swelling of the cells (Gardos effect).

Complications of vascular access in hemodialysis (HD)--aged vs adult patients.

Reports on the success of permanent vascular access in elderly HD patients vary considerably. We reviewed the records of 149 patients [62F and 87M] aged 20-89 years old (median 59) who were on hemodialysis for 6-242 (49 median) months, and had undergone 202 vascular access procedures (177 Cimmino-Brescia fistulae and 25 PTFE grafts). Patients were divided into two groups according to the age they started HD. Group A: 48 patients, over 60 years old (range 60-83; median 70) on HD for 43.5, (6-140) months. Group B: 101 patients, under 60 years old, range (15-59) median 46, on HD for 54 (6-242) months. There were no differences between the two groups in terms of gender, primary renal disease, (except polycystic kidney disease), Hct and EPO administration. The initial choice of vascular access, the complications and the technique survival were examined in both groups. Cimmino-Brescia fistulae were used as the first choice of vascular access in all patients except one in group B. PTFE-grafts were the second or third choice in 7/48 (group A) and 15/101 (group B) (p: NS). The only reason for technique failure was vascular thrombosis in both groups (11/48 group A and 31/101 group B p: NS). Other complications were: aneurysms (10/48 and 14/101, p: NS), infections (0/48 and 2/101 p: NS) and edema (0/48 and 6/101, p: NS). Five-year technique survival of the first AV fistula in the two groups was 35% and 45% respectively (log-rank test, p: NS). These findings suggest that: a) A.V. fistula is the first choice of vascular access in aged HD patients; b) There is no difference in vascular access complications across age groups; c) Survival of the first A.V. fistula is independent of age.

Successful use of recombinant human erythropoietin in a pregnant woman with lupus nephritis.

Recombinant human erythropoietin (r-HuEPO) is broadly accepted as treatment for anemia in dialysis and nondialysis patients with chronic renal failure, but data regarding the safety and efficacy of this drug in pregnancy are limited. Maternal and fetal problems have been reported to be associated with anemia during pregnancy. On the other hand, anemia is a frequent feature of systemic lupus erythematosus. We report the successful use of r-HuEPO in a young woman with lupus nephritis complicated by severe anemia during pregnancy. Additional studies should be encouraged to confirm the safety of r-HuEPO therapy during pregnancy.

Incidence of tuberculosis in Greek armed forces from 1965-1993.

Studies investigating the epidemiology of tuberculosis in Greece are lacking. Tuberculosis (TB) continues to be a public health problem and its dimensions are not clearly defined. The aim of this study was to estimate the incidence of pulmonary and pleural TB in each of the three branches of military personnel serving in the Greek armed forces, during the period 1965-1993. All military personnel with confirmed pulmonary or pleural TB during the period 1965-1993 were studied retrospectively. The age of the patients ranged from 18-45 years. A significant number of TB patients were detected by the regular chest radiography screening using mass miniature radiography during enrollment. The diagnosis of TB was made both by clinical and paraclinical examinations, such as history, symptoms, physical examination, tuberculin skin reactivity, chest X-ray and/or computed tomography of the thorax, bronchoscopy, microbiological examination of specimens (sputum, washings, bronchoalveolar lavage) as well as histological and bacteriological examination of the biopsies. We found that during the period studied, 4,628 patients were hospitalised for TB, 3,588 for pulmonary TB, and 1,040 for TB pleuritis (3,781 in the army, 445 in the navy and 402 in the air force). In 1965, the incidence (per 100,000) of TB (pulmonary and pleural) in the army was 60, in the navy 50, and in the air force 30. This incidence increased gradually from 1965 to 1980, followed by a decrease, since BCG vaccination became obligatory in 1980; values in 1993 were 18 in the army, 25 in the navy, and 15 in the air force. These figures are significantly higher than those reported for the civilian population, probably due to underreporting in the latter. Our results suggest that the incidence of TB in the Greek armed forces, although still high, is declining steadily. Strengthening of the anti-TB campaign is indicated.