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Background: The aim of this study was to compare the incidence of abdominal and incisional hernias in patients with abdominal aortic aneurysm (AAA) versus patients with aortoiliac occlusive disease (AOD)., Patients and Methods: The study included retrospectively 121 patients, who underwent elective aortic surgery due to AAA (n = 63) or AOD (n = 58) in the period between January 1998 and January 2000. The patients were examined for the presence of abdominal hernias upon admission, as well as for the development of incisional hernias on follow-up., Results: The incidence of inguinal hernias was significantly higher in the group AAA (21/6-33.3%) compared to the group with AOD (6/58-10.3%) (p < 0.01). The incidence of other abdominal wall hernias (umbilical, epigastric or miscellaneous hernias) was also significant higher in AAA group. Furthermore, the incidence of inguinal hernias was significantly higher in the subgroup of patients with an aneurysm diameter more than 6 cm (41.5% vs 18.2%, p < 0.05). The mean follow-up of the patients was 1.7 +/- 0.3 years. 7 cases of incisional hernia were noted in the AAA group (11.1%) and only 2 cases in the AOD group (3.4%) (p < 0.05). The size of the aneurysm had no influence on the incidence of incisional hernias in the AAA group., Conclusion: We conclude that there seems to be an increased incidence of abdominal wall hernias as well as postoperative incisional hernias in patients undergoing aortic surgery for aneurysm disease compared with aortoiliac occlusive disease.

Background: Almost 70% of all gynecological consultations in perimenopausal women are related to irregular uterine bleeding. In this prospective study, we compared endometrial assessment by transvaginal ultrasonography (TVS) in perimenopausal women with irregular uterine bleeding to histological assessment and tested whether the TVS was effective as a diagnostic tool for the detection of endometrial pathology in these women., Materials and Methods: Eighty consecutive perimenopausal women complaining of irregular uterine bleeding participated in the study. The women were evaluated by transvaginal scans, performed immediately before endometrial biopsy. The ultrasonographic results were compared with the histological diagnosis obtained from the endometrial biopsy., Results: Sixty-seven out of 80 women (83.7%) had normal histological findings, whereas 13 (16.3%) had abnormal findings. No endometrial cancer was diagnosed in this cohort of women. In the 67 women with a histological diagnosis of normal endometrium, mean+/-SD endometrial thickness was 10.5+/-4.0 mm (range 4.0-18.5 mm), whereas the corresponding value in the 13 women with abnormal findings was 18.7+/-3.8 mm (range 13.5-22.5 mm). If a 13 mm cut-off limit was used for endometrial thickness, which would include all abnormal cases, the sensitivity, specificity and positive predictive values were 100%, 71.64% and 40.62%, respectively., Conclusion: TVS can identify women with perimenopausal bleeding in which the likelihood of endometrial pathology is high and in which tissue sampling should be performed. Thus, TVS can be a primary method of selecting women with perimenopausal bleeding who must be further investigated with more invasive methods such as endometrial biopsy.

Background: Application and removal of an infrarenal aortic clamp is associated with changes in oxygen consumption, especially when collateral perfusion is limited. Carbon dioxide production during abdominal aortic clamping is expected also to change. The aim of this study was to evaluate the alterations of CO2 release during abdominal aortic surgery., Design: prospective study., Setting: University Hospital, Greece., Patients: 17 patients undergoing abdominal aortic aneurismal (AAA) repair and 8 patients undergoing repair of aortoiliac occlusive disease., Intervention: intraoperative record or calculation of PaCO2, PetCO2, PECO2, VD, VDalv, and VCO2. Patients with aneurysms were randomly divided to have constant ventilation (group AA) or modified ventilation to preserve normocapnia (group AB) during clamping. Ventilation was kept constant in the occlusive patients group (group OD)., Results: Patients with AAA showed a significant decrease of VCO2 during clamping and an elevation after unclamping in both groups (AA and AB), with no difference of statistical importance between them. During clamping, PetCO2/ PaCO2 ratio was decreased and VDalv was increased especially in group AA, while unclamping produced the opposite effect. Occlusive patients showed insignificant alterations., Conclusions: Our results suggest that, the calculated alveolar dead space is only an indicator of the true V/Q in patients with AAA, because it is strongly dependent on the CO2 load to the lungs, which is markedly altered in the same period. The modification of ventilation during clamping based only on PetCO2 and not on arterial sampling, could possibly lead to hypercarbia in these patients.

The failure of five recent clinical trials to show significant reduction in elevated serum cholesterol by a single brand of allicin-standardized garlic powder tablets is in contrast to many prior positive studies with the same brand. The hypocholesterolemic activity of garlic is mainly due to allicin, a compound that is produced by the acid-sensitive garlic enzyme, alliinase, only after tablet consumption. Therefore, the allicin-releasing ability of ten lots of these tablets--manufactured over the same years that the positive and negative clinical trials were conducted (1989-1997)--was determined under simulated gastrointestinal dissolution conditions, as defined by U.S. Pharmacopeia Method 724A. It was found that the older lots were more resistant to acid-disintegration (2.5 h vs. 1.3 h, P < 0.001) and that they released three times as much allicin (44% vs. 15 % of their potential, P < 0.001) as the newer lots. A second brand of tablets employed in a recent negative trial released no detectable amount of allicin, while a third set of tablets with high allicin release was used in a trial that gave positive effects. Hence, the persons involved in the recent negative clinical trials probably received considerably less allicin than did those in the older positive studies, possibly accounting for much of the discrepancy in the outcomes. In conclusion, clinical trials using garlic powder tablets to assess any effect of garlic that might be related to allicin, as most are, cannot be considered valid for garlic when the trial shows no effect, unless the expected allicin release from the tablets has at least been determined under standardized drug release conditions (USP 724A).

The radiographic technique factors and the quality of each radiographic image for three common examinations (chest PA, pelvis AP and lumbar spine LAT) were compared with the European criteria and entrance surface dose (ESD) was measured for each radiograph in two Greek hospitals. The measurements were carried out using calibrated LiF thermoluminescence dosemeters. The patients were selected so that their weight was close to 70 +/- 10 kg and their height to 170 +/- 10 cm. Effective dose values were calculated using a PC-based Monte Carlo program. All four X ray rooms in the survey achieved mean doses well below the European reference doses. However the mean doses in the X ray rooms differed by a factor of about 3.

Background: The aim of this study is to evaluate the intravascular multiparameter sensor Paratrend 7 (P7) for continuous acid-base and blood gas monitoring after retrograde jugular catheterization during carotid endarterectomy., Patients and Methods: We studied 11 patients with history of smoking (72.7%), coronary artery disease (72.7%), hypertension (100%), diabetes mellitus (55.5%) and TIA's and/or nondisabling stroke (90.9%). The contralateral internal jugular vein was punctured retrogradely and the calibrated P7 sensor was introduced. The sensor was removed after surgery. The P7 provides continuous graphical display of pH, pCO2, and pO2, while temperature, oxygen saturation, HCO3 concentration and base excess are displayed numerically., Results: Mean duration of carotid cross-clamping was 17.0 +/- 6.2 min. Mean stump pressure was 50.2 +/- 12.9 mmHg. Intraluminal shunting was not used in any operation. All sensors were easily inserted. During clamping, pH became persistently more acidic (7.31 to 7.28; p < 0.05), pCO2 was elevated (44.7 to 49.8 mmHg; p < 0.05) while, in the majority of the patients, there was a non significant decrease in pjvO2/SjvO2. Declamping was followed by a short period of decrease of pH and elevation of pCO2 reminiscent of wash out phenomena. PjvO2 was significantly elevated (53.8 +/- 5.2 to 59.0 +/- 5.8 mmHg; p < 0.001) after the restoration of flow. In one case, P7 was diagnostic for unsuccessful endarterectomy., Conclusions: P7 is useful during carotid endarterectomy providing continuous and "on-line" information on brain metabolism. It is a simple and powerful technique, which should be further investigated.

Objective: This study aimed at examining the detection rate of congenital abnormalities by using routine ultrasonography at 18-22 weeks of gestation., Methods: The sample included 7,236 fetuses. A detailed sonographic examination was performed in each fetus and a neonatal evaluation or pathology examination was made to confirm the prenatal findings., Results: The total prevalence of fetal abnormalities in our sample was 2.24% (162/7,236). There were 29/162 (17.9%) fetuses with CNS abnormalities, 27/162 (16.7%) fetuses with gastrointestinal abnormalities, and 28/162 (17.3%) fetuses with urinary tract abnormalities. There were also 31/162 (19.1%) fetuses with cardiovascular abnormalities, 26/162 (16.0%) with malformation of the limbs and musculoskeletal system, and 21/162 (13%) fetuses with other various abnormalities. The overall sensitivity in detecting fetuses with congenital abnormalities was 80.25% (130/162). The sensitivity per system was 93.1% (27/29) for CNS, 45.2% (14/31) for cardiovascular system, 85.2% (23/27) for gastrointestinal system, 85.7% (24/28) for urinary system, 84.6% (22/26) for musculoskeletal system, and 95.2% (20/21) for the rest of the abnormalities detected. We performed 40 pregnancy terminations in the group of malformed fetuses. Among the fetuses considered as normal, 1.7% had chromosomal abnormalities., Conclusions: The results indicate that routine sonographic examination at 18-22 weeks of gestation can detect the majority of congenital abnormalities. More experience is needed for the examination of the cardiovascular system, where the sensitivity was particularly low (14/31 or 45.2%).

Objective: To evaluate the rate of recurrence after conservative treatment of Stage 1 borderline ovarian tumors., Methods: Retrospective case note review of all women with borderline ovarian tumours diagnosed at Aberdeen, U.K. and loannina, Greece between 1981-1993. Outcome measures comprised initial surgery, stage of disease, histological type, pregnancy rate, recurrence rate and disease-free interval., Results: Conservative surgery for borderline tumours in young women permitted high conception rates. Recurrence of tumour was high in this group, 71%, and presented late., Conclusion: Prolonged intensive follow-up is required for women treated conservatively for borderline malignant ovarian tumours.

The endogenous signals controlling liver regeneration are becoming rapidly defined. One of the key findings during liver regeneration following partial hepatectomy is the appearance of peripheral blood factors that stimulate DNA synthesis in the parenchymal cells. Hepatopoietin A, or hepatocyte growth factor, has been described as a complete mitogen for hepatocytes, one of its major tissue sources being the pancreas. The changes in the rate of DNA synthesis (incorporation of [3H] thymidine into DNA) in both subtotally pancreatectomized-partially hepatectomized (Group A) and partially hepatectomized (Group B) male rats were determined at different postoperation times. DNA synthesis in Group A was increased progressively, reaching a maximum at 40 hr after operation in contrast to the 24- and 32-hr peaks obtained in nonpancreatectomized rats (Group B). However, liver regeneration in Group A was significantly lower than in Group B. To evaluate the effects of hepatic stimulator substance (HSS) on liver regeneration, the time course of HSS biological activity during the liver regeneration process was determined in the livers of Group A rats. A concurrent change of HSS activity and rate of liver regeneration was observed. These results support the hypothesis that HSS biological activity may be delayed but not suppressed by subtotal pancreatectomy.

The assumption that epipolar lines are parallel to image scan lines is made in many algorithms for stereo analysis. If valid, it enables the search for corresponding image features to be confined to one dimension and, hence, simplified. An algorithm that generates a vertically aligned stereo pair by warped resampling is described. The method uses grey scale image matching between the components of the stereo pair but confined to feature points.

Single-dose antibiotic therapy for uncomplicated infection of the lower urinary tract (UTI) in women has resulted in high success rates. Ciprofloxacin, like other new quinolones, has shown good in vitro activity against the pathogens most frequently encountered in UTI, high concentrations in the urine and is well tolerated. The present report describes a randomized, double-blind, controlled trial of two single-dose regimens of ciprofloxacin in women with lower UTI. Thirty-six women received 250 mg and forty-two received 500 mg of ciprofloxacin as a single dose. Escherichia coli was the most frequently isolated pathogen in both groups (forty-eight patients). Clinical and bacteriological cures were attained in 81% and 93% of the 250 mg and 500 mg dose groups, respectively, 7 days after treatment. Follow-up at 4 weeks after completion of treatment disclosed that the clinical cure rate was 62% and 79% respectively. Ciprofloxacin was well tolerated. This study shows that a single dose of ciprofloxacin is an effective and safe treatment of uncomplicated UTI. Although the cure rates were higher with a single dose of 500 mg, further studies are needed for assessment to determine the optimal dose.

Solutions of ampicillin, carbenicillin, methicillin, oxacillin, penicillin G, and cephalothin in 5% dextrose were analyzed by nickel(II)-catalyzed hydroxylaminolysis. The reactions of these antibiotics were complete within 20 min at room temperature. Under the analytical conditions, molar absorptivities of the ferric-hydroxamate complexes ranged from 830 to 1005 liters/mole/cm. Coefficients of variation for the analysis of these antibiotics in 5% dextrose were typically less than 3% at concentrations of 1 mg/ml. Oxacillin was analyzed by the same method in normal saline and/or lactated Ringer solutions. The method also was applied to the analysis of chloramphenicol in aqueous solutions. Only ampicillin showed a significant decrease in concentration in 48 hr.

Renal papillary necrosis was induced in rats by daily subcutaneous injection of 15 mg 2-bromoethylamine hydrobromide (BEA) per 100 g of body weight for 2 successive days. This dose was 50% higher than that reported previously. Beta adrenergic receptor blockade with oxyprenolol did not influence the kidney damage. The administration of heparin did not show any effect. The doses applied did not induce the incoagulability for a sufficient period of time. On the contrary, treatment with hydrocortisone decreased papillary necrosis without inducing increased diuresis.

A case of torsion of the gallbladder is presented. Torsion of the gallbladder is uncommon and should be remembered in right upper quadrant acute abdomens, especially in elderly, asthenic individuals.

The effects of hydrocortisone administration in rats intoxicated with one injection of 75 mg galactosamine i.p. per 100 g of body weight are described. Hydrocortisone was given at two schedules; according to the first schedule it was given at the dose of 150 microgram per 100 g of body weight i.p. 1 min before galactosamine administration and after 6 hours at half this dose, while according to the second the animals were pretreated for 24 hours before galactosamine injection at 6 hour intervals four times at the dose of 150 microgram. Both treatments diminished significantly liver cell necrosis induced by galactosamine and lowered serum transaminases activities (P less than 0.001). Liver glycogen depletion and excessive fatty accumulation found in the animals that had received galactosamine alone did not exist after hydrocortisone treatment. The protective hydrocortisone effect is briefly discussed, the present findings remaining unknown.