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This paper presents the management systems employed by the client organization Egnatia Odos A.E. (EOAE) responsible for the design, construction and maintenance of Egnatia Motorway’s bridges in Northern Greece. The management systems for the design phase, including procedures for the award of design contracts, internal review and external independent checking of the procured designs are discussed. For the supervision of bridge construction, EOAE enforces a strict quality control and quality assurance system, including application of relevant procedures and testing at every stage of construction. These, as well as the bridge maintenance program are also described. In addition, the project monitoring systems employed to provide immediate access to design information and facilitate effective planning of the works, as well as the Quality Assurance System used to ensure that the quality of the bridges meet state-of-the-art standards, are presented. whilst Metsovitikos and Votonosi Bridge with the main spans of approximately 235m will be among the longest span balanced cantilever bridges in Europe.

The investigation of 117 infertile couples in a clinical practice is reported. Results of testicular biopsies were categorized as follows: Type 1 normal testis; Type 2 germinal cell aplasia; Type 3 germinal cell arrest; and Type 4 sloughing effect. A diagnosis of block in the epididymis or vas was made by injecting saline up the vas toward the urethra and by finding inspissated spermatozoa in the distended tubules of the epididymis. (This method was later replaced by radiologic evidence of the patency of the vas by vasography and epididymography.) 2 men were found to have Klinefelters syndrome. Local surgical conditions associated with infertility were noted in 7 cases. There were 36 infertile men with seemingly normal semen. A strongly positive Kibricks macroagglutination test was found in the plasma of 9 of these men and similar antibodies were noted in 5 of their wives. Of the 22 men with aspermia an obvious explanation existed in 8 cases (e.g. Klinefelters syndrome retrograde ejaculation mechanical obstruction). The sloughing effect was noted in 11 of the 14 men without an obvious cause for aspermia. Oligospermia was diagnosed in 60 men. Testicular biopsies in 21 of these cases revealed the sloughing effect in 10 specimens germinal cell arrest in 3 and aplasia in 8. Of the 29 oligospermic men treated with fluoxymesterone 14 showed improved sperm density and all showed improved motility. Sustained improvement in sperm density was observed in 11 of the 25 men treated with clomiphene. Only patients who showed sloughing off in the biopsy had improvement with either treatment method; however sloughing did not always predict an improvement in sperm density. The persistently oligospermic man may be helped by artificial insemination of centrifuged semen or by pooling concentrated sperm. Plasma antisperm antibodies can be washed off spermatozoa and a concentrated specimen of semen injected directly into the cervix. Pregnancy has been achieved in 3 of the 12 cases where this method was tried. Finally in cases with a positive Kibricks reaction in the wifes plasma prednisone can be administered to the woman over the period of artificial insemination with washed spermatozoa. This has achieved 1 pregnancy to date in this series.

We have employed an immunohistochemical analysis to study the ras p21 oncoprotein in a total of 41 brain tumors and 1 reactive gliosis. The tumors included 33 astrocytomas, 1 oligodendroglioma, 2 ependymomas, 1 neurilemmoma, 1 malignant meningioma, 1 neuroblastoma and 2 medulloblastomas. Our results indicate that elevated ras p21 expression is a common feature in a range of brain tumors. In particular, elevated ras p21 expression has been found in 18 out of 24 high grade astrocytomas (malignant astrocytomas and glioblastomas multiforme) compared to 3 out of 9 low grade (well differentiated astrocytomas) (P less than 0.05). These results suggest that ras p21 expression may be an important molecular marker of the malignant astrocytomas and glioblastomas multiforme.

Background Surgeons are at risk for developing work-related musculoskeletal symptoms (WMS). The present study aims to examine the physical factors and their association with WMS among pediatric laparoscopic surgeons. Methods A questionnaire consisting of 21 questions was created and mailed to 25 pediatric laparoscopic surgeons (LG). 23/25 surgeons (92%) completed the survey. The questionnaire was analyzed and then split into 2 groups. Group 1 (LG1) included surgeons with greater laparoscopic experience, and group 2 (LG2) included surgeons with less important laparoscopic experience. In addition, we constructed and sent to the same surgeons a similar questionnaire focused on WMS after an open procedure (OG) with the aim to compare results of LG with OG. Results The prevalence rate of WMS with shoulder symptoms was 78.2% in surgeons that performed laparoscopy for more than 10years, with 60.8% also reporting other pain. In 66.6% this pain is evident only after a long-lasting procedure. Forty-four percent of these surgeons require painkillers at least twice a week. Fifty percent of these surgeons also suffer at home. Fifty-five and one half percent of surgeons indicate that this pain is related to their laparoscopic activity. Forty-three and a half percent think that laparoscopy is beneficial only for the patient but has a bad ergonomic effect for surgeons. Sixty-five and two-tenths percent think that robotic surgery can be helpful to improve ergonomics. Comparing the groups, WMS occur more frequently in LG (78.2%) than in OG (56.5%), but this difference was not statistically significant (χ 2 =0.05). In addition, WMS occur more frequently in LG1 (84.6%) than in LG2 (70%), but this difference was not statistically significant (χ 2 =0.05). Conclusions These results confirmed a strong association between WMS and the number of laparoscopic procedures performed. Skilled laparoscopic surgeons have more pain than less skilled laparoscopic surgeons. WMS in the same group of surgeons are more frequent after laparoscopy than after open procedures. The majority of surgeons refer to shoulder symptoms.

Thymic cysts are rare embryonic remnants along the course of thymic migration in the neck or the anterior mediastinum which may result in cervical masses in children, often misdiagnosed. We present the experience gained by three European tertiary care medical centers in the treatment of thymic cysts as well as the current data on the embryology, clinical presentation, diagnosis and management of thymic cysts. A retrospective study was carried out in nine patients with thymic cysts during the period 1986-2002 at the departments of Pediatric Surgery of Children's University Hospital "Federico II" and "Santobono" Pediatric Hospital of Naples in Italy and "Aghia Sophia" Children's Hospital of Athens in Greece. All cases were asymptomatic, appearing mainly as masses resembling branchial cyst or lymphatic malformation. Laboratory and imaging investigations were not useful for preoperative diagnosis. In one case the mass extended into the mediastinum. The histological findings of thymic tissue and Hassal's corpuscles in the cystic wall were diagnostic. In all cases, surgery was successful and uneventful. Surgical excision was accomplished by dissection of the cystic masses from the jugular vein, carotid artery and vagus nerve and from the sternocleidomastoid muscle. The presence of a normal thymus in the mediastinum must be documented preoperatively in order to avoid the risk of total thymectomy. If a cervical thymic cyst extends into the normal thymus, attempts should be made to preserve the thymus, especially in younger patients. Thymic cysts should always be included in the differential diagnosis of lateral cervical masses, especially in children.