Received: 27.10.2009 Accepted: Original Article The Effects of Finasteride and Azelaic Acid on Skin Flap Viability in Rats Marjan Ajami1, Mohamad Ali Nilforoushzadeh2, Shahab Babakoohi3, Rouhollah Habibey4, Fatemeh Banimostafa Arab3, Niloofar Pazoki-Toroudi3, Mehdi Rashighi-Firoozabadi3, Alireza Firooz3, Yahya Dowlati3, Hamidreza Pazoki-Toroudi5
from the President of the Congress On behalf of the Organizing Com-
multi-approach discussion on
mittee I have the pleasure to wel-
"quality in clinical practice" will
come you to the 2nd World
eventually affect to the better the
Congress on "Quality in Clinical
quality of life of our patients.
We would like to believe that the
The first congress, two years ago,
selection of 8 round tables, 6 sym-
was marked as a very successful
posiums, 2 lectures, 3 satellite
event not only because of the
symposiums, 1 workshop and the
number of attendances and the
3-poster symposiums, certifies the
very high quality level of presenta-
tions but mostly due to the active
participation of all of us in its ses-
At the same time we hope to give
the opportunity to accompanying
persons to luxuriate the incorpo-
We hope to witness the same now
ration of culture, sun and sea of
as well, in order for the congress's
goal, which is to give to the Health
Scientists a podium to present the
Dear friends, we would like to
most recent facts of their disci-
thank you cordially for your pres-
pline in terms of diagnosis, med-
ence and participation at the pres-
ical research and accurate appli-
ent scientific event and we wish
cation of newer methods and tech-
you to enjoy creatively these four
niques, to be fulfilled.
days at the beautiful and hos-
Such a forum to clinical scientists
pitable peninsula of Halkidiki.
from many specialties and with a
A. A. Vidalis MD,PhD
President, HPGH and
President, 2nd World Congress
"Quality in Medical Practice"
Honorary Chair Persons
Bullinger M., Professor of Medical Psychology, Germany
Kanakoudi - Tsakalidou F., Professor of Pediatrics, Greece
Kaprinis G., Professor of Psychiatry, Greece
Kotsis A., Professor of Biology, Greece
Mantalenakis S., Em. Professor of Obstetrics and Gynaecology, Greece
Panayi G., Professor of Reumatology, England
Ravens - Sieberer U., PhD, MPH, Psychology, Germany
Spyrou P., Professor of Cardiovascular surgery, Greece
Chairman: Vidalis A., MD, PhD, Director, Psychiatry, Greece
MD, PhD, Cardiovascular Surgeon
Assoc. Professor, Cardiologist
Gerasimidis Th. Professor, Surgeon
Assoc. Professor, Immunologist
Assoc. Professor, Pediatrician
Professor, Obstetrician - Gynaecologist
MD PhD, Assoc. Director, Nephrologist
Scientific Committee Karavatos A. Greece
Power M. Great Britain
Alexandropoulos K. Greece
Kiriopoulos J. Greece
Raju S. Great Britain
Angelopoulos N. Greece
Kogeorgos J. Greece
Rambavilas A. Greece
Angomachalalelis N. Greece
Kontopoulos E. Greece
RhysEvans P. Great Britain
Antoniadis A. Greece
Koopman H. Netherlands
Rogotis Chr. Greece
Arvanitakis K. Greece
Kremenopoulos G. Greece
Sakadamis A. Greece
Atmatzidis K. Greece
Lazaridis L. Greece
Schuhfried O. Austria
Auquier P. France
Lefkos N. Greece
Sidiropoulos J. Greece
Avramidis A. Greece
Leplège A. France
Simeoni M.-C. France
Baloyiannis S. Greece
Lionis Ch. Greece
Sitzoglou K. Greece
Barbullushi M. Albania
Loufopoulos A. Greece
Souliotis K. Greece
Brockington I. Great Britain Lyketsos C. USA
Spenser J. Great Britain
Chaplin J. Sweden
Lymberis M. USA
Stamatopoulos P. Greece
Felton D. Great Britain
Makedos G. Greece
Steward D. Canada
Fokas K. Greece
Mavreas V. Greece
Tampakoudis P. Greece
Fountoulakis K. Greece
Miserlis Gr. Greece
Tantanasis Ch. Greece
Garyfallos G. Greece
Nenov D. Bulgaria
Theodoropoulou S. Greece
Giannoulis Ch. Greece
Niero M. Italy
Toptsis K. Greece
Guldner N. Germany
Oreopoulos D. Canada
Traianidis P. Greece
Halbreich U. USA
Panteliadis Ch. Greece
Tsakiris D. Greece
Harlaftis N. Greece
Papadimitriou M. Greece
Tsanakas J. Greece
Hunt S. USA
Papanikolaou A. Greece
Tsitsopoulos Ph. Greece
Idrizi A. Albania
Papathanasiou K. Greece
Tzebelikos E. Greece
Imvrios G. Greece
Papavasiliou A. Greece
Variemezis V. Greece
Ivanovski N. FYROM
Pekovic G.P. Yugoslavia
Verrips E. Netherlands
Kambanoudis A. Greece
Petrides G. USA
Xaidemenos G. Greece
Kandilis D. Greece
Pintor Pinna P. Italy
Yfantopoulos I. Greece
Karagiannis A. Greece
Pournaras I. Greece
Zafiriou D. Greece
Scientific Secretariat Didaskalou Th. - Tsilikas S. - Syngelakis M.
TERPSIHORI & ERATO 17.00 - 18.15
BEYOND THE USUAL GENERAL HOSPITAL CONSULTATION-LIAISONPSYCHIATRIC PRACTICE Chairman: A. Vidalis
"Psychiatric issues in transplant patients".
"Delirium and atypical antipsychotics. A clinical perspective".
"INF-· treatment for HCV in a psychotic patient".
TERPSIHORI & ERATO
18.15 - 20.15
HYPERTENSION: NEW ASPECTS AND THERAPIES Chairmen: G. Vergoulas and D. Nenov
"Essential hypertension: new aspects on pathophysiology and treatment".
"Treatment of hypertension in patients with glomerular disease: is anything new?"
"Hypertension in patients on CAPD: pathophysiology and treatment".
"Hypertension in patients on Chronic Hemodialysis: pathophysiology and treatment".
G. Perunicic – Pekovic
"The use of new antihypertensive agents after renal transplantation".
TERPSIHORI & ERATO
20.15 - 21.00
NIKOLAUS DUMBA (1830 - 1900). A MAECENAS OF THE ARTS Speaker: J. Tzafettas
TERPSIHORI & ERATO
21.00 - 23.30
TERPSIHORI & ERATO 09.00 - 10.15
Chairman: D. Efstratopoulos
"Assessing the treatment constellation: Past, present and future treatment standards for
the management of dyslipidemia".
"The current and future outlooks for regression of atherosclerosis: Next steps toward the
S. M. Voyaki
"The search for superior treatment: Current and future options for dyslipidemia".
CHLOE & THALIA
09.00 - 11.30
DISCUSSION OF PAPERS NUMBER P01-P33
Chair-persons: D. Jonova and E. Chatziagorou
CHLOE & THALIA
11.45 - 13.30
DISCUSSION OF PAPERS NUMBER P34-P66
Chair-persons: Ch. Tsonidis and K. Fountoulakis
CHLOE & THALIA
17.00 - 19.00
DISCUSSION OF PAPERS NUMBER P67-P99
Chair-persons: Z. Racic and Gr. Misirlis
TERPSIHORI & ERATO
10.15 - 11.30
QUALITY OF LIFE OF CARDIAC SURGICAL PATIENTS Chairman: A. Economidis
"Patient that underwent valve-replacement".
"Patient with aneurysm-thoracic aorta".
TERPSIHORI & ERATO 11.45 - 13.00
ADVANCES IN CONGESTIVE HEART FAILURE MANAGEMENT AND QUALITY OF LIFE Chairmen: G. Louridas and P. Geleris
"Advance in CHF diagnosis".
"Medical management on CHF and quality of life".
"Surgical treatment of CHF and quality of life".
TERPSIHORI & ERATO
13.00 - 13.30
Chairman: G. Louridas
FOR A GOOD CLINICAL PRACTICE: PRESCRIBE RATIONALLY P. Block
TERPSIHORI & ERATO 17.00 - 18.15
BRAIN & BEHAVIOUR International Society
EVERYDAY PSYCHIATRIC CLINICAL PRACTICE AND QUALITY OF LIFE Chairman: G. Kaprinis
"Psychopharmaceutical agents and quality of life".
"Psychotherapy and quality of life".
"Psychoprophylaxis and quality of life".
"Sexual relationships and quality of life".
TERPSIHORI & ERATO 18.15 - 19.00
EUROPEAN APPROACH TO QUALITY OF LIFE ASSESSMENT IN CHILDREN: THEDISABKIDS - PROJECT Chairman: M. Bullinger
"Assessing quality of life in children with chronic conditions".
"Listening to what children say: the role of focus-groups in developing quality of life meas-
"Development of disease specific measures: how specific to do we have to be in assessing
the quality of life within chronic conditions - the exampleof asthma".
"Practical use of quality of life assessment in research and the clinical context".
TERPSIHORI & ERATO 19.00 - 20.30
QoL OF CHILDREN WITH CHRONIC DISEASES Chairmen: Ch. Panteliadis and J. Tsikoulas
"New options in the management of cerebral palsy: correlation with quality of life".
J. Tsikoulas, D. Zafeiriou, E. Doulianaki
"QoL of school children with epilepsy".
E. Pavlidou, M. Tzitiridou and Ch. Panteliadis
"QoL in oncological patients".
K. Gombakis – Pistevou
"Current management of the inflammatory bowel disease in children".
St. Karyda – Kavaliotis
TERPSIHORI & ERATO
09.00 - 10.15
INFECTION CONTROL IN THE OPERATING ROOM Chairman: N. Harlaftis
"Planning and designing of the operating room".
S. Syrakou - Chatzicocoli
"Surgical site injection: Environnemental control and O.R. practices".
CHLOE & THALIA 09.45 - 11.00
LONG-TERM MANAGEMENT OF SCHIZOPHRENIA Chairman: G. Kaprinis
"Antypsychotic treatment: Possibilities, Limitations, Perspectives".
"Risperidone Long Acting: Correlations with social rehabilitation".
WITH THE KIND GRAND OF JANSSEN-CILAG
TERPSIHORI & ERATO 10.15 - 11.45
QUALITY OF LIFE IN DERMATOLOGY Chair-persons: G. Chaidemenos, O. Mourellou-Tsatsou and F. Chryssomallis
"General and specific quality of life indexes in dermatology".
"Corrective cosmetology in dermatology".
WITH THE KIND GRAND OF VICHY LABORATORIES
TERPSIHORI & ERATO
11.45 - 13.00
ASSISTED HUMAN REPRODUCTION: WHERE WE STAND TODAY A QUARTEROF A CENTURY AFTER LUISE BROWN'S BIRTH Chairmen: J. Tzafettas and A. Loufopoulos
"Improvement in the quality and the results of infertility treatment after the
routine use of in vitro fertilization and other assisted reproduction techniques".
"Surgical management of ovarian stimulation".
"The impact of technological advances in the field of human reproduction".
TERPSIHORI & ERATO 13.00 - 14.15
RECOGNITION AND CONFRONTATION OF DEPRESSION: PRESUPPOSITION OF AQUALITY MEDICAL PRACTICE Chairman: G. Kaprinis
"Depression in the daily practice in General Hospital".
"Depression and quality of life in third age patients".
"Antidepressant drugs and special groups of patients".
WITH THE KIND GRAND OF ORGANON HELLAS AEE
TERPSIHORI & ERATO 14.30 - 17.30
HOW TO MEASURE QUALITY OF LIFE: METHODOLOGICAL, ETHICAL ANDCULTURAL ISSUES "Criteria for selecting the appropriate quality of life instrument".
"Evaluating quality of life measurements".
TERPSIHORI & ERATO
17.30 - 18.30
Chairman: A. Vidalis
"Redefining the optimum goal. Response vs Remission".
WITH THE KIND GRAND OF WYETH
TERPSIHORI & ERATO 19.30 - 10.45
PROGRESS IN THE QUALITY OF MANAGEMENT OF PRENATAL DIAGNOSIS Chairmen: A. Athanasiades and J. Tzafettas
"Diagnosis and therapy of fetal anomalies".
"Potentials and limitations of modern ultrasonography in contemporary obstetrics.
"Fetal reduction in high rate multiple pregnancies: clinical management and bio-ethics".
TERPSIHORI & ERATO
10.45 - 12.00
GREEK MULTIPLE SCLEROSIS Society
THE ROLE OF PSYCHOLOGICAL SUPPORT TO THE QUALITY OF LIFE IN PATIENTS WITH MULTIPLE SCLEROSIS Chairman: A. Orologas
"Psychological support of persons with Multiple Sclerosis".
"Psychological support of relatives, of persons with Multiple Sclerosis".
"Psychological support of children, of persons with Multiple Sclerosis".
TERPSIHORI & ERATO 12.00 - 13.15
GREEK ASSOCIATION of GP's
QUALITY ASSURANCE ON GENERAL PRACTICE/FAMILY MEDICINE Chairman: Ch. Lionis
"Measuring quality of care in chronic primary care patients in Greece".
"Approaches to quality within general practice/family medicine using electronic aids:
Towards to the development of an operational system in Greece".
A. K. Karotsis
"Timing for the establishment of Global Quality in General practice medicine professional
TERPSIHORI & ERATO 13.15 - 14.15
HEALTH AND HEALTH SERVICES: ECONOMICS & ADMINISTRATIONS Chairman: K. Souliotis
"Quality of life and medical drugs".
"The role of pharmaceutical industry to the rendering of health services".
TERPSIHORI & ERATO 14.15 - 15.00
3rd World Congress
on Quality in Clinical Practice,
will be held September 2006,
Thessaloniki - Greece
Further information will follow shortly.
FOR A GOOD CLINICAL PRACTICE : PRESCRIBE RATIONALLY
P. BLOCK, MD, PhD, FESC, FACC Div of Cardiology - Academisch Ziekenhuis VUB (Free University Brus-sels) - Belgium One of the periquisites of good clinical practice is to prescribe ration-ally by restricting the number of drugs to those which have proven tobe effective and - even better - cost-effective with no or few side effectsand interaction with food and/or other drugs. Priority will be given tolong acting drugs (24h). Only so we can expect a good therapeutic com-pliance and efficacy.
How will these drugs be preferentially selected? Mainly on the base ofevidence based medicine (EBM). It means that our therapeuticschemes (and diagnostic tools) will rest on proof of effectiveness. Inother words that these drugs and interventions have shown in goodconducted large clinical trials (mega-trials) or in pooled smaller trials(meta-analysis) to reduce the total and specific mortality and morbidi-ty. How to express the efficacy? By calculating the relative- and evenbetter - absolute risk reductions (RR), which can be done by mention-ing the odds ratios (OR) and confidence intervals (CI). The calculationof the absolute RR is necessary if we want to analyze and compare thecost-effectiveness of various intervention modalities, which can also beimportant for the definition of priorities in reimbursement by thenational and/or private health insurance systems. In absence of such information, and only as long as such data don'texist, our prescription practice may still rest on our own clinical expe-rience and on pathophysiological data. Eventually, but in second pri-ority, drugs improving solely the quality of life can be added, as farhowever as they don't interfere negatively with drugs proven to beeffective on EBM. Finally we have to be aware that increasing the number of daily takendrugs decreases the patient's drug tolerability and compliance.
Some statistical notions will be explicated and examples of the cardio-vascular field given. Dimitris Sotiriadis, MD, PhD, Associate Professor of Dermatology Department of Dermatology, "Aristotle" University, Thessaloniki Genital herpes is a recurrent, life-long viral infection. Two viruses ofthe same family cause herpes genitalis: HSV-1 and HSV-2. Most cases(95%) of recurrent genital herpes are caused by HSV-2.
The majority of patients infected with HSV-2 are not diagnosedbecause the infection has been transmitted by persons unaware thatthey suffer from herpes or, who are asymptomatic when transmissionoccurs.
Diagnosis of genital herpes often causes considerable distress and hasa tremendous negative impact on the Quality Of Life (QOL) for thoseinfected. The complex web of social, physical and emotional conse-quences often has a synergistic effect that cannot be explained solelyby the physical condition itself. There have been a few recent international surveys that have studiedthe QOL impact among those infected with genital herpes. The mostcommon emotional responses are depression, anguish, anger, diminu-tion of self-esteem and hostility towards the person believed to be thesource of the infection. These emotional problems appear to be worsein women than in men. About 50% of patients with recurrent genitalherpes felt that their effectiveness at work had been substantiallydiminished because of their disorder, 75% worried about social rejec-tion, over a quarter had suicidal thoughts and in nearly 80% of thepatients the disease had a profound effect on their sexual life. Guilt and anger are common emotions. It is important to note that thecondition is often dormant for many years. Over a period of more than2 years 30% of patients felt sad or depressed on most days. The sever-ity of symptoms during relapses, the associated shame, depression andthe social stigma may play a large role in compromising quality of life.
Treatment with antiviral agents, taking into account not only numberof recurrences, but also personal attitude towards the disease, canprobably reduce anxiety, assist adjustment and improve QOL of thepatients and patients' sexual partners. NEW OPTIONS IN THE MANAGEMENT OF CEREBRAL PALSY:
CORRELATION WITH QUALITY OF LIFE
I Tsikoulas, DI Zafeiriou, E Doulianaki In order to improve quality of life in children with cerebral palsy (CP),it is crucial to choose the most appropriated therapeutic options for theindividual patient. To reach this target, we should be aware of: 1) Thedefinition and the etiology of CP, its natural course, as well as addi-tional neurological impairments and disabilities 2) The tools which canassess the severity and the specific symptomatology, as well as thecourse of the individual CP case. For this purpose, the knowledge ofthe various contemporary assessment tools of function and disabilityin CP (GMFM, QUEST, PODCI, PEDI, COPM etc) is important 3) Thecurrent therapeutic approaches towards CP patients. The importance of multidisciplinary approach in order to provide a comprehensive treatment plan should be stressed. A number of inter-ventions that relax or lengthen muscles, or reduce muscle spasms, areused in order to interfere with movement and posture problems; suchinterventions include pharmacotherapy (systemic, local or intrathecal),surgical therapy (orthopedic, neurosurgery) and rehabilitation. Theinterventions that will be discussed in this round table represent ourclinical experience (especially regsrding chemodenervation with bot-ulinum toxin as well as current information from the literature regard-ing various agents currently used to treat spasticity and muscle over-activity in children with CP.
QUALITY OF LIFE IN DERMATOLOGY
Olga Mourellou-Tsatsou MD, PhD Director of Hospital for skin and Venereal Disease of Thessaloniki Psoriasis is a chronic inflammatory skin disease in which the signsvary from one patient to another and over time. Traditionally, physi-cians have used various parameters to assess the severity of the dis-ease: percentage of body area covered (BSA), erytheme, plaque thick-ness, degree of scaling (PASI score) and systemic symptoms such asitch and pain of arthritis. However these clinical assessments alone do not accurately reflect theoverall effect of the disease on patients' daily activities. Apart from theclinical severity of affected areas psoriasis can also have a profoundpsychological impact on the patients' quality of life (QOL) namely ontheir life style, emotional wellbeing and the social ramifications of liv-ing with the disease. Various types of questionnaire have been developed to collect informa-tion from the patient's perspective about physical and mental healthas well as other aspects related to their families, friends and sociallives. The Dermatology Life Quality Index (DLQI) is a self-administered,simple and practical questionnaire designed to measure the impact ofskin diseases on patients QOL. The instrument contains 6 subscalescores: symptoms and feelings; daily activities; pleasure; work-school;personal relationships and treatment. The score on the DLQI has apossible range of 0 to 30, with 30 corresponding to the worst. The DLQIhas evidence supporting reliability and validity when used in a derma-tology clinical setting.
The psoriasis symptom assessment (PSA) scale contains 8 symptomsquestions related to psoriasis, to which the patient responds in termsof frequency and severity (troublesomeness/bothersomeness). EachPSA score ranges from 0 to 32, with 32 indicating the worst. PSA is thefirst symptom measure which intends to assess the effects of skin dis-ease on the patient HRQL (Health related quality of life). Itch scalesVAS and NPF offer a useful information about itchiness. PSA and itchscales demonstrate responsiveness to changes in clinical status andhave significant correlations with clinical indicators at the same timeperiod. PSAQOL is a valuable tool for assessing the impact of inter-ventions for psoriatic arthritis in clinical studies. It is well accepted bypatients, is easy to administer and has excellent scaling and psycho-metric properties.
Conclusion: The DLQI, the PSA, VAS, the NPF and the PSAQOL areconsidered useful tools for the measurement of dermatology relatedlimitations of functional ability and the frequency, severity and impactof psoriasis symptoms on patients' lives and psoriasis-related QOL. ATOPIC DERMATITIS AND QUALITY OF LIFE
Dr. Ioanna Mandekou-Lefaki State Hospital for Skin and Venereal Diseases, Thessaloniki, Greece Atopic dermatitis affects different aspects of patient's quality of life.
Apart of that, there is an impact on parents and other family members.
Depending on patients' age there are several types of quality of lifeindex:- IDQoL or Infants' Dermatology Quality of Life Index, score 0-34, isspecific for evaluation of quality of life of young children aged underthe age of 4years.
- CDLQI or Childrens' Dermatology Life Quality Index, score 0-30points, is specific for older children aged from 9 to 16 years.
- QoLIAD or Quality of Life Index Atopic Dermatitis, score 0-25 points,is specific for patients over the age of 16 years and adults.
The impact on the life of parents of children aged up to 8 years ismeasured by Parents' Index of Quality of Life in Atopic Dermatitis,PIQoL-AD, score 0-25.
Quality of life measures should be used in conjunction with clinicalmeasures for global assessments of disease impact.
Changes in Index scores are determined before, during and after ther-apy to assess treatment benefits.
GENERAL AND SPECIFIC QUALITY OF LIFE INDEXES IN
Demetrios Ioannides, MD Assoc. Professor Of Dermatology Various types of questionnaire have been designed in an attempt toevaluate patients' quality of life (QoL). They generally include questionsabout physical and mental health, as well as other aspects related totheir professional and social lives and to their families and friends.
These questionnaires are divided into two categories: general-healthand skin-disease specific questionnaires. They provide a thorough andscientific basis to measure the benefits of a treatment, in terms of whatis important to patients. It is beeter to emphasize that these question-naires should be used with caution in order to avoid raising issuespatients would not otherwise put forward.
The general-health questionnaires include items, which are usuallygrouped into psychological, social and physical domains. Their useallows the concerns of people with a skin disease to be compared withthose of patients with other conditions and with healthy controls. How-ever, such questionnaires can be complex and time-consuming to com-plete. The skin-disease specific questionnaires can be used in conjunctionwith general-health questionnaires. They are useful for comparing QoLacross a variety of skin diseases, but not between different conditionsor populations. Patients' beliefs about their skin disease are examined,namely causes, consequences, chronicity or recurrence, symptomsand controllability, etc. It is interesting for the evaluation of varioustreatment modalities to assess the relationship between these beliefsand the clinical severity of skin condition. CURRENT MANAGEMENT OF THE INFLAMMATORY BOWEL
DISEASE IN CHILDREN
St. Karyda-Kavaliotis MD, PhD Consultant Paediatric Gastoenterologist1st Dept of Paediatrics, Aristotle University of ThessalonikiThessaloniki – Greece Inflammatory bowel disease (IBD) in children includes Crohn's disease(CD),ulcerative colitis (UC) and indeterminate colitis (IC). CD can involveany part of the gastrointestinal tract from the mouth to the anus butmost often affects the lower part of the small intestine. UC involvesonly the colon and most often the left colon. In addition to symptomaticdisability, affected children may have chronic malnutrition, lineargrowth failure and pubertal delay. The course of these diseases is usu-ally lifelong with recurrent exacerbations and remissions of intestinaland other systemic features. Therefore, interferes seriously with thequality of life due to severe morbidity.
Like other chronic illnesses, management should include considera-tion of the social, cultural and psychological circumstances of the childand his (her) family. The consequences of the illness and side effects ofits treatment may affect other members of the family and the patientin a complex interrelationship between the child, the family and thesocial milieu. Management of IBD should therefore include, within thecomprehensive treatment program, consideration of the psychosocialsituation of the child and other members of the family. It is importantto be aware of the numerous problems that these families encounterso that appropriate help can be offered. Therapy for IBD is designed for induction of remission of disease activ-ity, maintenance of remission and prevention of relapse. There arethree specific modalities of treatment for IBD in childhood: nutritionaltherapy, medical therapies and surgery. At present, none of these iscurative.
A. NUTRITIONAL THERAPY1. Total parenteral nutrition (TPN) In children TPN is generally reserved for patients with serious ill-ness especially when there are profusely discharging fistulae andeither before of after surgery (ideally preoperatively) in malnour-ished children 2. Enteral nutrition There is mounting evidence supporting the use of enteral feeding inchildren, especially in those with new onset CD. With enteral feed-ing, nutrition is improved, and growth and pubertal developmentcan be promoted, while avoiding the systemic toxicity of corticos-teroid therapy. Enteral nutrition may promote maintenance ofremission in children with CD. B. MEDICAL THERAPY1. Aminosalicylates The aminosalicylates, sulfalazine (SASP) and 5-aminosalicylic acid(5-ASA, mesalazine) are the first-line drugs that have modest anti-inflammatory effects. Although there have been few carefully con-ducted trials of these drugs in children to assess their place in man-agement, it is accepted that these drugs so effective in UC, haveshown minimal efficacy at best in maintaining remission in CD. Chil-dren seem to tolerate mesalazine better than sulfasalazine. In thetreatment of paediatric IBD, fear of side effects has causedmesalazine to be more popular than sulfasalazine, which, however ischeaper .
2. Corticosteroids Along with sulfalazine and the 5-ASA preparations, corticosteroidsare extensively used as a primary treatment of both CD and UC.
These medications are very effective in controlling active CD and UC,accounting for clinical remission rates of 60-91%. There is howeverno benefit from steroid maintenance therapy in either disease. Toxi-city is the major drawback, accounting for high morbidity. The mostimportant side effects are bone demineralization and growth retar-dation. Several antibiotics have been found to be useful in mild cases of IBD.
These include metronidazole and ciprofloxacin. Metronidazole seemsto be safe and relatively effective in perianal CD in children (heals fis-tulas). 4. Immune modulating drugs (IMD)a. Azathioprine (AZA), 6-mercaptopurine (6-MP) In patients with chronically active CD or UC with frequent exacer-bations, maintenance treatment with AZA or 6-MP is safe and effi-cacious. A steroid-sparing effect has been demonstrated in 70-75%of paediatric patients with CD or UV. The onset of action is slow (3-4 months) so, awaiting a response treatment needs to be combinedfor at least 3 months. Bone marrow depression may occur in 2-5% of patrients at any time.
Concerns about malignancies after long term treatment are not sup-ported by evidence from the available literature. Cyclosporine may be useful in patients with severe refractory ulcer-ative colitis to avoid emergency colectomy. For closure of refractoryfistulas in patients with CD, cyclosporine is effective. Side effectssuch as hypertrichosis and paresthesias are frequent. The risk ofrenal damage limits its use as a long term drug.
c. Methotrexate (MTX) MTX is beneficial and steroid sparing in CD but not in UC. In chil-dren with CD, experience with MTX is limited but encouraging. MTX should only be considered in children with CD who fail to respond toconventional drug or who are having significant side effects fromother therapies. 5. Biological agents.
Anti-Tumor Necrosis Factor-a antibody (anti-TNF antibody)Anti-TNF antibody is very effective in active and fistulizing CD. Sev-eral trials of anti-TNF antibody have been done, all showing promis-ing results in children. Whether this agent treatment eliminates theneed for steroids in paediatric CD, is a matter of controversy. In chil-dren with UC, small studies have demonstrated encouraging short-term results of anti-TNF antibody in moderate to severe disease. Themost important side effect is the development of active tuberculosisafter initiation of anti-TNF antibody. Development of malignancies isa concern and cancer surveillance is indicated. Despite advances in the medical treatment of IBD, there remain dis-tinct indications for surgical resection in both UC and CD. Appro-priate timing of surgery and choice of procedure may allow growthacceleration and pubertal advance that cannot yet be achieved med-ically. Delay in colectomy for toxic megacolon remains a potentialcause of fatality. Optimizing surgical outcome minimizing the needfor ileostomy and preventing disease recurrence in CD or chronicpouchitis in UC, remain areas for future paediatric research. DELIRIUM AND ATYPICAL ANTIPSYCHOTICS. A CLINICAL
A. VaksevanisPsychiatric Department, Hippocratio General Hospital, Thessaloniki,Greece Delirium is an organic psychiatric syndrome characterized by fluctu-ating consciousness and impairment in cognition perception andbehavior. The disturbance develops over a short period of time, usual-ly hours to days. Antipsychotics have been the medication of choice inthe treatment of delirium. Haloperidol, a high potency neuroleptic hasgenerally been considered the antipsychotic medication of first choicein the treatment of delirium. However, Haloperidol is frequently associated with extrapyramidalsymptoms, particulary in older adults. Recently, several case studieshave been published evaluating the use of atypical antipsychoticagents in treating patients with delirium. The new atypical antipsy-chotics offer another possibility, though this is limited by the low num-ber of publications about their use and the lack of double blind stud-ies. Moreover, from another aspect, there is the absence of formal indi-cation for delirium. Recent announcements from the manufacturers ofOlanzapine and Risperidone refer to the increased danger of mortalitydue to the use of these drugs in the elderly suffering from dementiawith a previous history of vascular cerebral disorders. Further studies are required to evaluate the efficacy and safety of new atypical antipsy-chotics.
During a period of six months, the Department of Consultation-LiaisonPsychiatry received 179 requests for visits. From the 179 patients, 48of them were diagnosed with delirium. They were followed and exam-ined on a daily basis during their stay in the various clinics to whichthey were admitted and daily cooperation with their doctors occurred.
Information was also obtained from nursing staff and the family envi-ronment. The assessment of the course of delirium took place with theD.R.S. (Delirium Rating Scale). Clinical necessity has led us to useatypical antipsychotics on patients and the initial results seem to bepositive. THE ROLE OF MAGNESIUM IN INSULIN RESISTANCE SYNDROME
Rasic-Milutinovic Z1, Perunicic-Pekovic G2, Pljesa S2, Dangiç A3, Kos-tic N4, Samardzija V5, Bokan Lj6 1Clinical Endocrinology Unit, 2Clinical Nephrology and HemodialysisUnit University hospital Zemun-Beograd, 3Faculty of mining and geol-ogy, 4Faculty of agroculture Beograd, 5Transfusion Unit Universityhospital Zemun-Beograd, 6Bichemical Laboratory University hospitalZemun-Beograd, Serbia and Montenegro Introduciton. Previous studies have reported inconsistent results aboutthe effects of intracellular Mg concentration on insulin action and inci-dence of diabetes mellitus type 2. Material and methods. The study wasrandomized, cross-sectional, with two groups of subjects, 90 healthypersons and 38 patients with Type 2 diabetes (mean age 31.56±10.35years vs 37.66±9.62 years,p=0.08) treated with diet only. This studyaimed to examine the relationship between plasma Mg, Ca, glucose,insulin concentration and insulin resistance index (HOMA IR), calcu-lated from fasting serum insulin and glucose concentration by Homeo-static Model Assessment score.
Results. The group of Type 2 diabetic subjects didn't differ from healthygroup for age, gender, systolic blood pressure and plasma Na, Ca, Cland iP concentrations. Plasma level of Mg was lower significantly in dia-betic subjects (0.84±0.24 vs. 0.87±0.31, p=0.04). Calculated IR hasshown significantly higher level in diabetes mellitus type 2 (4.8±2.4 vs.
1.7±0.8,p=0.02) as well as glucose level (6.36±1.10mmol/l vs. 4.16±0.93mmol/l, p=0.01), as was expected. We have shown significantassociation between plasma level of Mg and glucose, insulin, insulinsensitivity index and BMI, in both group of subjects, separately.
In conclusion, our study suggested that magnesium might have someprotective effect in modulating insulin action in healthy persons andworsening of insulin resistance in patients with diabetes mellitus type2. In farther study we will develop our study on drinking water compo-sition, especially of Mg and Ca. COPING WITH THE PSYCHOLOGICAL EFFECTS OF VITILIGO:
COMPARING THERAPEUTIC APPROACHES
Litsa Anthis, Linda Papadopoulos, Carl Walker London Guildhall University, Psychology Department, Calcutta HouseOld Castle Street, E1 7NT, London, United Kingdom Objective: Vitiligo is a progressive condition involving a loss of pig-mentation in the skin. It can be disfiguring and no fully effective treat-ment or cure exists. Although medical effects of vitiligo have been stud- ied extensively, little attention has been paid to its psychologicalimpact. This research compared the efficacy of cognitive-behaviouraltherapy and person-centred (humanistic) therapy in both group andindividual format, with respect to ameliorating the disabling effects ofthe condition. Procedure: Participants were matched for age, sex and ethnicity andwere randomly allocated to either, the control group, the CBT treat-ment group or the humanistic treatment group. Participants under-went 8 consecutive weeks of therapy and psychological and physiolog-ical gains were recorded before therapy, after therapy and at follow-up.
Results: The study used a mixed factorial design for the questionnaireanalysis. The independent factor was the three different experimentalconditions; control, CBT and humanistic therapy and the repeatedmeasures factor was assessment point; pre-treatment, post-treatment,6 month follow-up and 12 month follow-up. The research highlightedthe beneficial effects that psychological therapy can bring to vitiligopatients.
Conclusions: This research helps us to understand more fully the effi-cacy of psychological therapy with a vitiligo population and will helpdirect health professionals to the most appropriate format for future use.
EPIDEMIOLOGICAL DATA OF GUILLAIN-BARRE SYNDROME FOR 5
Sallabanda S, Kola E, Lluka R, Zavalani F, Bakalli I, Qatipi M, Kito I,Mati L,Koja B Departament of Pediatrics, UHC "Mother Thereza" Tirana, Albania.
The aim: To present the epidemiological data of severe forms of Guil-lain-Barre Syndrome, (GBS), their clinical and laboratory particulari-ties and to emphasize the importance of mechanical ventilation for thetreatment and outcome of the patients admitted at PICU during theperiod 1999-2003.
Material and Method: This is a retrospective study. The patients admit-ted at PICU met the diagnostic criteria of GBS, according to Ad HocNINCDS Committee. We have considered as severe the forms that haverequired mechanical ventilation. The virology examinations are per-formed at National Institute of Public Health.
Results and Discussion: We enrolled 6 children with GBS according tobefore mentioned criteria. They constituted 12% of all admissions withGBS during the same period of time. Two cases (33,3%) came fromurban areas and four (66,6%) from rural ones. The most affected agewas from 2 to 6 years old, (4 cases-66,6%). The greatest part of thepatients was admitted during humid seasons. The most predominatingsymptom was symmetric muscular weakness, beginning at lowerextremities, in 6 cases-100%), and progressing within 6-48 hours toupper extremities (66,6%), affecting oro-pharyngeal and respiratorymuscles and resulting in tetraplegia. All the patients had bicipital, patellar and cutano-abdominal hypoareflexia. The sensibility wasaffected, (hypoesthesia), in (83,3%), and it wasn't affected in 1 case(16,6%). One patient had the Miller-Fisher variant, determined clini-cally and by revealing the circulating anti gangliosidal antibodies. In 3cases (50%) the syndrome was preceded by respiratory infections, oneof which had a positive test of cold agglutination for Mycoplasma pneu-moniae. Only one case had a CSF proteino-cytologic dissociation. Fourcases required mechanical ventilation, on the average two days afteradmission, because they met the criteria of decompensated ARF. Theystayed on mechanical ventilation 31 days average. All the patients wastreated with IVIG. Three patients, (50%) were complicated with noso-comial infections and two of them had positive cultures of bronchialsecretions for Pseudomonas aeruginosa. The clinical improvement hasbegun on the average 4 weeks after the admission and it has lasted upto a year. The outcome has been very good, with no mortality and withfully recovery. Only one patient had neurological sequelae.
Conclusion: 1) The ventilatory assistance is a key point in the excellent recovery ofthese patients. 2) We have the problem of nosocomial infectios.
We are at the first steps of the use of IVIG for the treatment of GBS.
LOW DENSITY LIPOPROTEIN SUBCLASS DISTRIBUTION IN
Sonja Alabakovska, Danica Labudovic, Katerina Tosheska, BojanaTodorova Department of Medical and Experimental Biochemistry, Faculty ofMedicine, University "Ss. Cyril and Methodius", Skopje, Macedonia Background: Current reports claim that small and dense LDL particlesare more atherogenic than larger LDL particles. There are many stud-ies presenting LDL subclass distribution in adults, but there is notenough literature data on this problem found in childhood. The aim ofthis study was to examine LDL subclass distribution in healthy chil-dren in R. Macedonia. Materials/Methods: Plasma LDL subclasses in 100 children aged 9-18years were analyzed using non-denaturing polyacrilamide gradient (3-31%) gel electrophoresis. Conventional plasma lipid and apoproteinparameters which are thought to affect LDL size were determined aswell.
Results: The results obtained have shown prevalence of large LDL sub-classes (phenotype A) in 89% of the children, whereas small LDL sub-classes (phenotype B) were observed in 11%. The mean LDL size was26,37± 0.68 nm, and there was no difference between gender groups.
No association between LDL size and plasma lipid, apoprotein levels,age and BMI was noted.
Conclusion: These findings indicate that LDL size and distribution isgenetically determined and is not gender and age dependent. Also, it is not influenced by the plasma lipid and apoprotein concentrations inchildhood which suggest that analysis of LDL subclass phenotype mayprovide better information on the risk of atherosclerosis developmentin adulthood.
SPECIFIC INFANT FORMULA IMPROVES QUALITY OF LIFE IN
Xinias Ioannis, Demertzidou Vasiliki, Kardaras Panagiotis, Nalmpan-ti Filareti, Staurakaki Evgenia, Tsiouris Ioannis, Papastaurou Theo-duli, Spiroglou Kleomenis Third Department of Pediatrics, Aristotle University, HippocrationHospital, Thessaloniki, Greece Cow's milk allergy and lactose malabsorption have suggested as acause of infantile colic and other gastrointestinal manifestations. Thegoal of our study was to investigate the effectiveness of a specifichypoallergenic, lactose free infantile formula in infants with colicwith/or without other gastrointestinal symptoms. Patients and methods: 15 children aged 1.5-3.5 months, who sufferedfrom infantile colic (according to international criteria), were includedin the study. A questionnaire of two parts was made for the requirements of thestudy. Colic episodes per day, regurgitation and vomiting as so as timeof crying, duration of sleep, constipation and body parameters werecarefully registered in the first part of the questionnaire. In the 2ndpart of questionnaire personal and familial history of allergy, as so asspecific IgE (RAST), total IgE and blood eosinophils were measured andregistered. A lactose free infant formula, with hydrolyzed protein(whey) was administered to all infants. After one month feeding withthis specific formula all the parameters that referred in part one of thequestionnaire were reevaluated and registered. Results: colic episodes decreased after feeding with specific formula(from 4± 2 to 1.53± 1.59/day, p< 0.05). Moreover significant (P<0.05)elimination of regurgitation and vomiting episodes per day andimprovement in cases with constipation was recorded. Cryingepisodes per day also decreased but not very significantly. It wasremarkable that weight gain was according to expected values for theage of the infants (median body weight before=6300 gr, median bodyweight after specific milk formula=7260 gr) and the other body param-eters were as expected. From the medical history allergic manifesta-tions referred in 33%, familial history of allergy in 20% of the cases,eosinophilia in 20%, positive RAST tests in 20%, and elevated total IgEin 26%. Conclusions: Infantile colic with or without other gastrointestinalsymptoms can effectively managed with whey hydrolyzed, lactose freeformula. This finding supports the possible relation between cow' smilk allergy, lactose absorption and infantile colic. AN OBESITY-SPECIFIC QUALITY OF LIFE INSTRUMENT:
OAS - ADAPTATION IN GREEK
Giaglis G.D., Goulis D.G., Kita M., Kontopoulos M., Avramides A.
Department of Endocrinology, Hippocration General Hospital, 54646Thessaloniki, Greece Introduction: The impact of obesity on Health Related Quality of Life(HRQoL) has been less well studied than how it affects physical mor-bidity. For these purpose there are few questionnaires that are gener-ic and do not focus on the specific features of obesity. Obesity Assess-ment Questionnaire (OAS) is such an obesity-specific HRQoL measure.
Aim: The translation and adaptation in Greek of OAS and the develop-ment of an abridged version.
Methods: OAS was translated following the standard forward-backwardprocedure and was adapted in Greek by a panel of experts in the field.
Following it was examined for reliability (internal consistency and test-retest repeatability), and construct validity. The 6 items with the highestitem-total correlation were selected to construct the abridged version.
Results: A high degree of internal consistency was observed both forthe original and the abridged version (Cronbach's a was 0.9042 and0.8903 respectively). Test-retest repeatability correlation coefficientsfor both versions were highly significant. The Greek OAS demonstrat-ed adequate construct validity as measured by its correlation to gener-ic HRQoL tools, like SF-36 and European Quality of Life-5 Dimensions.
Conclusions: The OAS addresses the relevant domains of obesity spe-cific HRQoL, is psychometrically sound, and has been linguisticallyvalidated into the Greek language. An abridged version is also avail-able. These questionnaires are readily self-administered in research orclinical settings. HYPERKALEMIA-RELATED RHYTHM DISTURBANCES IN ELDERLY
Alexoudis Apostolos, Borghi Luisa, Karakiriou Maria, Xaritos Stefanos,Dourtsiou Stella, Gotsis Alexandros, Terzi Sofia, Panagiotidou Alexandra Clinic of Cardiology-General Hospital of Komotini. Purpose: Presentation of three patients with rhythm disturbances dueto hyperkalemia.
Methods: we studied 3 patients, a 71-year-old man and two women aged69 and 83. Two of them had a history of congestive heart failure whilethe other one suffered from hypertension. On admission, they presenteddizziness, weakness to the lower limbs and vomiting. There was no his-tory of diabetes mellitus or gastroenteritis, but one patient presented ini-tial stage of renal insufficiency. In the first patient hyperkalemia was induced by intoxication of digitalis, while in the others there was a his-tory of long-term therapy with potassium sparing diuretics andangiotensin-converting enzyme (ACE) inhibitors. All patients were underECG monitoring and a 6-hour- control of arterial blood gases.
Results: ECG showed: a) tall and peaked T waves in the precordialleads, b) in two cases a reduction in P wave amplitude with its subse-quent disappearance c) a progressive widening of the QRS complex ,with QRS> 112 ms, QT> 282 ms, a QTC> 324 ms with RR>764ms d)AV nodal rhythm in two cases e) in one case a ventricular tachycardiawhich was degenerated in torsade de pointes ventricular tachycardiaand subsequently in ventricular fibrillation. Arterial blood gasesanalysis: pH 7.29±0.05, K+ (mmol/l) 7.61±0.11, Na+ (mmol/l): 136±2,HCO3-(mmol/l):19.8±6.5.
Conclusions: Hyperkalemia is associated with various arrhytmiaswhich could be life threatening. The correlation between the serum levelof potassium and the induced ECG changes are neither precise nor con-sistent. Elderly patients with a history of long-term therapy with ACEinhibitors and digitalis are more susceptible to hyperkalemia when theyalso have gastroenteric disturbances or chronic renal insufficiency.
ROLE OF GENERAL PRACTIONERS IN PREVENTION AND/OR EARLY
DIAGNOSIS OF BREAST CANCER
Paliogianni E, Koutsiogianni Z, Mantouvalou M, Kyriazopoulos G,Frontzou R Lamia general hospital, ICU department Background and goals of study: the objective of our study was toassess the role of general practitioners in first degree of health, withregard to the prevention of breast cancer . Material and method: we studied 820 women of age from 32 -83years, that reached the mammography centre Lamia. General hos-pital. The women emanate from the wider region of Fthiotida (rural,semi-urban, urban population). Examination included personalinterview, reception of background from the radiologist, completionof a questionnaire, physical examination including palpation and themammography. Results: the overwhelming majority of women who reached us for amammography came after dictation of doctors of other specialities(gynaecologists - obstetricians, surgeons, oncologists or internists,rural doctors), and only 9% from the general doctors. important roleplayed the mass media , while remarkable is that only 40% ofwomen came for the mammography after clinical examination (pal-pation of breast).T he rest were reported based only on the back-ground, while women that were advised to have a mammographyafter signs from the physical examination came, in their over-whelming majority, from obstetricians – gynaecologists. Importantis that 9% of women were submitted in mammography while having positive findings for breast cancer ,having lost precious time for pre-vention or cure. Conclusions: from this study we conclude to the following: The role of general doctor in the prevention of breast cancer is limit-ed. In Fthiotida the number of general doctors is small, having as aconsequence the insufficient application of preventive control of firstdegree on population (briefing, sensitization, suitable treatment).
There is no coordinated program of demographic control for breastcancer. It is indicative that mammographic department in Lamiahospital started its function only in 2003 and it covers a range ofpopulation of more than 180.000 residents.
OBSTRUCTIVE SLEEP APNEA SYNDROME AND DRIVING ABILITY.
EVALUATION OF PATIENT'S SUBJECTIVE OPINION
A.Triaridis, I.Konstantinidis, S.Triaridis, I.Petropoulos, K.Karagiannidis Otorhinolaryngology Department, Hippokratio General Hospital,Greece OBJECTIVE: Obstructive sleep apnea (OSA) has been shown to beassociated with an increased risk of road traffic accidents. Previousstudies are based on actual accident data, or on simulated driving per-formance of patients with OSA. The objective of this study was toassess patient's subjective opinion about their driving ability and thecorrelation with the results of polysomnography. MATERIAL– METHODS: Twenty-four patients with sleep disturbanceswere evaluated with polysomnography and endoscopic examinationwith Muller maneuver in our ENT department.
Patients completed the Epworth sleepiness scale (ESS), and a specialfocused (6-questions) driving ability questionnaire (DA). We correlatedthe results with the Apnoea - Hypopnea index of the patients (AHI) andthe Snore Index (SI).
RESULTS: Patients were divided in 4 groups, according their Apnea -Hypopnea index (AHI). We correlated the polysomnography results(Pearson's correlation coefficient, Spearman's rho and Kendall's tau-b)with the results of DA questionnaire. There was a significant correla-tion between the Apnea – Hypopnea index and the driving ability score.
Snoring was found to be a minor factor of decreased driving ability.
CONCLUSION: Obstructive Sleep Apnea Syndrome affects the qualityof patient's life. Day sleepiness in these patients threatens their life and life of otherpeople when they are driving. It is important to use special focusedquestionnaires in order to create an index of high-risk drivers whoneed further evaluation with objective methods like polysomnography.
Doctors must consider that the elimination of Snoring and OSAS inthese patients is associated not only with an improvement in quality oflife of these people, but also with a decrease in the risk of road traffic SWIMMING INJURIES AND PREVENTION
Akritidou A, Atsalou M K. Paleologou 13, 55133, Thessaloniki, Hellas Our intention in this project is to mention that in serious injuries inswimming, such as tendinosis of the supraspinatus muscle the train-ers, coaches, doctors and physiotherapists ought to take under con-sideration all the factors of injury in order to prevent it. But if it final-ly occurs, then the athlete's rehabilitation would be more complete andhis come back to training schedule easier.
We mainly focus the causes of the injury on the bad athlete's tech-nique. By reducing the pressure the athlete may not come to the sadposition of keeping himself from the swimming pool off for a while.
As a therapy, usually the conservative treatment is used apart fromwhen the injury is serious and chronic and no other treatment but thesurgical, i.e. operation is suggested.
The results of our study showed that from ten athletes that we exam-ined, with average age 21 years old, seven of them presented injury onthe shoulder, two of them on the back and one of them on the ankle.
Seven of them followed and completed their rehabilitation's programthat doctors and physiotherapists suggested, whereas three of theminterrupted their schedule due to their own personal reasons and con-tinued the training.
Consequently, the four swimmers were recovered and back to theirtraining program, whereas the situation of the other three relapsedand their injury became from acute into chronic. As a result the fre-quency of the injuries in swimming can be seriously reduced if thecoaches give priority and insist on the technique's improvement andthen on the performance. As well as, after the injury on the correctrehabilitation of the athlete and not on his quick come back in the pool.
THE IMPACT OF PREGNANCY ON PROGRESSION OF AUTOSOMAL
DOMINANT POLYCYSTIC KIDENY DISEASE
Alma Idrizi, Myftar Barbullushi, Margarita Gjata, Alketa Koroshi, Ari-ana Strakosha Service of Nephrology, UHC "M. Teresa", Tirana, Albania The aim of this study was to evaluate the influence of pregnancy to theprogression of autosomal dominant polycystic kidney disease(ADPKD). 55 females with ADPKD were included in the study during a period of10 years. Kaplan-Meier product-limit survival curves were construct-ed, and log rank test was used to compare the survival curves.
From 55 females pts, 52 of them had been pregnant: 22 of them hadhad less than three pregnancies (22%), [(7 of them had chronic renalfailure (CRF) – 1 underwent to renal loss, and 15 pts had normal renalfunction), while 30 pts had had three or more pregnancies (30%), (18of them had CRF – 9 underwent to renal loss, and 12 pts had normalrenal function). Having three or more pregnancies was associated with a worse renalsurvival than having less than three pregnancies (10-years differencein renal survival; P < 0.01). At the mean time, 16 pts with three ormore pregnancies had and hepatic cysts (7 of them underwent to renalloss), and 7 pts with less than three pregnancies had hepatic cysts (1of them underwent to renal loss). Our study showed that female patients with three or more pregnancieshave a greater risk to develop end stage renal disease than those withless than three pregnancies. Also, the females with three or more preg-nancies have a greater risk to develop hepatic cysts than patients withless than three pregnancies, suggesting for the role of estrogens in thegenesis of these cysts. TREATMENT OF INTERTROCHANTERIC HIP FRACTURES USING
INTRAMEDULLARY FIXATION. DOES IT IMPROVE THE EARLY
MOBILIZATION AND THE QUALITY OF LIFE OF THE PATIENTS?
Rizos Ch., Tsiampas D., Vardakas D., Chrisovitsinos I.
Department of orthopaedic surgery, General Hospital of Ioannina"G.Hatzikosta" Method. The last two years we have treated 31 intertrochanteric hipfractures using intramedullary nailing (Gamma – nail, IMHS, PFN). Themedian patient age was 76.4 years (range, 47 – 97 years). Forteen (14)fractures were stable and 17 unstable. The mean duration of hospitalstay was 6.9 days. The estimation of the results was based on data andx-rays of the medical files and also on phone information by them inperson or their relevants.
Results. Patients that were in a good general condition , were permittedto start mobilizing since the second postoperative day with partialweight bearing. One of the patients died the second postoperative day, two within thefirst month and two within the first year, but these two last, were walk-ing with crutches. Two (2) patients sustained pulmonary embolism andthey needed treatment. From this group of patients who are in life (26), twenty three are walk-ing without or with some help, but three of them remain confined to bed.
In one case "cut-out" of the lag screw from the femur head was observedand in another case intraoperative fracture of one cortice of the femur.
Conclusions. Our study demonstrates that this specific method of treat-ment (IMN) allows in greater percentage the early mobilization with par-tial weight bearing, reducing the complications of a prolonged lying incomparison to the latest method in use (DHS).
BITES AND STING INJURIES AS A CAUSE OF HOSPITALIZATION IN
CHILDREN. ∞ RETROSPECTIVE STUDY
N. Nikolakopoulou, M. Eliopoulou, I. Giannakopoulos, S. Mantagos Department of Paediatrics, University Hospital of Patras, Greece Objective: To study the clinical features, etiological agents of bites andsting injuries, clinical course, complications and treatment of childrenadmitted to our department.
Patient population: We retrospectively studied the medical records of201 children, 134 boys (66.7%) and 67 girls (33.3%), aged 7.24±3.5and 7.55±3.9 years respectively, admitted to our hospital with thediagnosis of bites and sting injuries from 1-1-1991 to 31-12-2002.
Results: The bites and sting injuries usually occurred in summer(62.7%), especially in July (28%), while they were less common inautumn (23.3%), spring (11%) and winter (3%). The frequency wasalmost the same during the 12 years of study period (14-20 cases peryear) and the majority of children (59.7%) were from rural areas. Theduration of hospitalization was 1.71±1.52 days. In the 75% of casesthe most common etiological agents were insect stings (hymenoptera35.3%, scorpions 13.4%, arthropods 4%, unknown insects 21.9%),12.9% snake bites, 6% jellyfish stings, 2.5% mouse bites. Usually,there was a high frequency of bites and stings in different parts of thelegs (36.3%). Patients were admitted to hospital in 2.5 h (range 0.25-48 h) from the bite. In 99% of patients, there were only local signs ofinflammation. In 36.3% of patients, the treatment was started beforethe admission in hospital. Systemic disease occurred only in 7 (3.5%)patients and complications were rare (2%). Most of the patients(81.6%) needed antibiotic, antihistamine, and steroid treatment.
Conclusion: The bites and sting injuries are not a very common causeof hospitalization in childhood and have a good prognosis under imme-diate and approppriate treatment. EPIDEMIOLOGY OF SUICIDE ∞∆∆∂ªPTS IN CHILDHOOD AND
ADOLESCENCE IN SOUTHWESTERN GREECE
Eliopoulou M.1, Assimakopoulou A.1, Katrivanou A.2, NikolakopoulouN.1, Giannakopoulos I.1, Mantagos S.1 1Department of Paediatrics, 2Department of Psychiatry, UniversityHospital of Patras, TK 265 04 Rion Achaias, Greece Objective: To study the epidemiological and clinical characteristics inattempts of suicide in childhood and adolescence.
Materials and Methods: We conducted a retrospective study of attempts of suicide in hospitalised children in Paediatric Clinic from1/1/1991-31/12/2001.
Results: There were listed 164 incidents of attempted suicide, 151 girls(92%) and 13 boys (8%), (age 8-16 years, mean 14.36 years). No differ-ence was observed in the number of incidents per year as well as theseasonal distribution. Higher frequency was observed during Marchand June (24 and 19 incidents respectively). The patients were fromurban regions (69.4%), semi-urban (17%) and rural (13.5%). Patientsreceived more frequently paracetamol, salicylicate in different combi-nation: each one separately or both together, or with other drugs ordomestic chemical substances. Potential lethal doses were received in57.3% of the patients. Patients were admitted in the hospital within 1 to 48 hours after thedrug was received (mean 6.8h) and 81% of them were in good generalcondition (65% of patients showed no pathological signs), whereas only2% were in severe general condition. No lethal incidence was reported.
Second incident of attempted suicide was noted in 3 of the patients.
Mood disorders and disruptive behavior were the most frequent find-ings during the paedopsychiatric assessment. Conclusions: The majority of suicide attempts were carried out usingdrugs and do not constitute important therapeutic problem but a bigsocial and domestic one. Systematic phycological follow up of the chil- dren is necessary as well as social support for their families. NUTRITION AND QUALITY OF LIFE IN ELDERLY PATIENTS
HOSPITALIZED FOR ACUTE DISEASE
Michailidou M, Panagiotou I, Skorda L, Papadimitriou K, GioulbasanisI, Mainas E, Latoufis C, Christoforidou M, Artikis V.
2nd and 3rd Department of Internal medicine, Elpis General Hospital,11522, Athens, Greece BACKGROUND: Inadequate nutrition is a major problem of the elder-ly today. A practical approach to estimate malnutrition's prevalence inclinical practice is screening with the Mini Nutritional Assessment(MNA). Little information is available on the nutritional status and thequality of life of elderly patients hospitalized for acute disease. AIM:The aim of our study was to evaluate the prevalence of malnutritionand to define its relationship with such patients' quality of life.
PATIENTS AND METHODS: Our study's cohort consisted of patientsaged > 65 years treated in our department for acute disease, during aone-year-period. On admission, data regarding each patient's resi-dence (home vs institution), socioeconomic status and family care(bad, moderate, good), use of medications and ability of daily activities(bad, moderate, good) were collected. The nutritional assessment (NA)scale was obtained for each individual patient through the applicationof the MNA protocol. The presence or absence of malnutrition was esti- mated, dividing our cohort in two subgroups. Statistical analysis com-paring life-quality parameters between subgroups was performed withthe "chi-square" test. RESULTS: 263 patients (112 men and 151women, mean age: 77.9+8.5) were studied. 81.3% lived at home priorto hospitalization and 77.1% had a good or moderate ability of dailyactivities. Based on the NA scale, 118 patients (44.8%) were malnour-ished. A significant positive relation was found between NA score andfamily care (p=0.042), socioeconomic status (p=0.012) and ability ofdaily activities (p<0.0001). CONCLUSIONS: Our study suggests that the nutritional status of eld-erly hospitalized patients is frequently inadequate, and that a closepositive relation between nutritional status and quality of life exists inthis group of patients. Healthcare providers should consider NA as aquick and easy nutritional assessment tool and could include it in anygeriatric assessment trying to evaluate quality of life.
MALE DIALYSIS PATIENTS ARE SUBJECT TO A HIGHER RATE OF
MUSCLE WASTING AND WEAKNESS THAN FEMALE
Sakkas, G.K.1, Stefanidis, I.2, and Johansen K.L.3 1Department of Medicine, University of California, San Francisco, USA.
2Division of Nephrology, University of Thessaly, Greece. 3Division of Nephrology, San Francisco Veterans Affairs Medical Cen-ter, USA. Gender has been shown to have an effect on muscle size, strength andperformance. However, in patients on dialysis treatment it is notknown whether gender plays a role in the degree of muscle wasting andweakness. Preliminary data have shown that male patients are moreaffected than female counterparts. We sought to determine whetherthe muscles of the lower leg are differentially affected in males andfemales with ESRD. Six healthy female controls (F-CON) were compared to 24 female dial-ysis patients (F-RFP) and 13 male controls (M-CON) compared to 27male dialysis patients for measurements in muscle cross sectional area(CSA) and composition by MRI, isometric leg muscle strength, bodycomposition by DEXA, physical activity by a 3D-accelerometry andphysical performance using functional tests.
The data were normalized for baseline differences between males andfemales by dividing the variables for each subject by the mean valuesof the sex-specific control group. ANOVA was performed to detect sta-tistical differences.
Muscle size in M-RPF group was reduced 10% more than in F-RFPgroup (p=0.01). Muscle strength was also reduced in M-RFP 5% morethan the F-RFP group (p=0.01). Intramuscular fat content was similarin all groups. On the other hand, F-RFP group had 20% more reduc- tion in gait speed than M-RFP group (p=0.01). Similar reduction inphysical activity levels, lean body mass and total body fat was found inboth dialysis groups. Testosterone concentration was highly correlatedwith muscle size in M-RFP group (R=0.554, p=0.001).
Male patients have a greater reduction in muscle size and strengththan female dialysis patients while female patients have a greaterreduction in gait speed. Hormonal changes seem may be a reason for those differences.
QUALITY OF LIFE IN PATIENTS WITH MULTIPLE MYELOMA IN
RECOMBINANT HUMAN ERYTHROPOIETIN ( RHU-EPO) TREATMENT
Caja T., Xhumari P.
University Hospital Center "Mother Tereza", Department of HematologyTirana-Albania Patients (pts) with Multiple Myeloma (MM) develop anemia that deteri-orates the quality of life and necessitates RBC transfusion, inevitableconnected with the risk of complications. Improvements of quality oflife after treatment with rHu-EPO often have been reported in pts withcancer.
Ojective: To evaluate the effectiveness of rHu-EPO in the treatment ofanemia associated with MM. Twenty pts with MM were enrolled into study. During the course ofchemotherapy all pts received rHu-EPO in the doses 150 U/kg threetimes a week subcutaneous. The pts were transfused when Hb levelfelt below 8.0 g/l.
Results: Anemia of different degree was observed in all pts. The indi-cations for RBC transfusion occured in 40% of pts on rHu-EPO treat-ment. Pts with response (80%) to the therapy significantly imrovedafter 8 weeks of treatment. The performance status before the start ofrHu-EPO therapy was more favorable and showed impressive improve-ment during the course of treatment. Clinical symptoms of anemiasubsided or at least considerably improved under successful rHu-EPOtherapy. No undesirable effects of rHu-EPO treatment were observed.
Conclusion: The use of rHu-EPO may reduce the requirements for RBCtransfusion in pts with MM under chemotherapy. RHu-EPO has anextended role in the managament of disease-related anemia and inquality of life in pts with MM. QUALITY OF LIFE AMONG CHRONIC HEMODIALYSIS PATIENTS AND
KIDNEY TRANSPLANT PATIENTS
Ospanova T., Semydotska Zh., Kotulevich N., Birjukova I. Dept. of Internal Diseases, Kharkiv State Medical University; RegionNephro-Urologic Center, 61174, 60, L. Svoboda av., fl.165, Kharkiv,Ukraine End-Stage Renal Disease (ESRD) is a non-curable condition for whichlife-long renal replacement therapy (dialysis or kidney transplantation)is required. Quality of life (QOL) is an important parameter of thetreatment adequacy in hemodialysis (HD) and kidney transplant (KT)patients (pts). To determine how renal replacement therapy influencesQOL in ESRD patients, we conducted a study applying the KidneyDisease Quality of Life (KDQOL-36TM) questionnaires. KDQOL-36TM disease-targeted items focus on particular health-relat-ed concerns of individuals with kidney disease and on dialysis: Symp-tom/problems, Effects of kidney disease, Burden of kidney disease.
KDQOL-36TM also includes a SF-12 Physical health composite (PHC)and SF-12 Mental health composite (MHC).
A total of 102 patients with ESRD were included. 86 pts mean age 41.8± 1.47 years have been treated on chronic HD 4 hours 2-3 times perweek. Dialysis age was 30.4 ± 3.2 months. They were clinically stablewith a mean KT/V 1.18 ± 0.2. 62% of pts were under anti-hyperten-sive treatment. QOL parameters were also evaluated in 16 kidneytransplant patients mean age 39.3 ± 7.2 years. Results show a signif-icant impairment of quality of life in HD pts compared to the Generalpopulation for all parameters except mental health (p<0.05). Higherage and co-morbidity were associated with lower quality of life. Hyper-tensive patients who received ACEI Enalopril and/or Human recombi-nant erythropoietin (HrEPO) "EPREX" had higher quality of life. LowerQOL was found in diabetic patients. Nutrition status, dialysis modali-ty, gender, and age, dialysis term were the independent factor whichimpact on QOL. QOL was better in all of domains except MHC in KTpts than in HD pts.
We conclude, KDQOL-36TM can be applied in evaluating of the ESRDtreatment. The QOL was better in transplant patients than in HD. Ane-mia correction, adequate treatment of hypertension, managing co-mor-bidity may improve QOL of pts who required renal replacement therapy.
THE RELATIONSHIP OF THE INTRACRANIAL PART OF VERTEBRAL
ARTERY TO THE CRANIAL NERVES AND THEIR CLINICAL
N. Milovanovic1, S.Draganic-Gajic2, C. G. Alexopulos1, D.Despotovic3,B. Filipovic3 1Institute of Anatomy, College of Cuprija, Serbia & Montenegro 2Psychiatric and Neurology Clinic, Medical Faculty Belgrade, Serbia &Montenegro3Institute of Anatomy, Medical Faculty Belgrade, Serbia & Montenegro, Our studies have been done on a hundred i slotted specimen of thebrain stem and the cerebellum of adult persons. In the course of ourstudies we have obtained the following results:1. The size of left vertebral artery (VA) occurs frequently 2-5 mm. and the size of the right VA occurs 2-4 mm. In the 45% of our cases thesize of the left VA was bigger then the right one.
2. The VA in its intracranial part goes generally ventromedially cross- ing the olive.
3. On its way though the posterior cranial fossa, both VA come to a close relationship with XII cranial nerve. Quite seldom the arteriesare in close relationship with the IX,X and XI nerve (8% on the right,7% on the left).In cases when the VA join above the fossa postpon-tina, making the basilar artery, they stand in close relationship withthe VI cranial nerve (4% on the right, 3% on the left). In cases ofmajor dislocations, the VA are in close relationship with the VII andVIII cranial nerve (3% on the right, 3% on the left).
These anatomical findings might have important clinical implications.
The data in the literature about the vascular compression of the cra-nial nerves cites symptoms and signs were due either to the impairednerve conduction only or to the demyelization and atrophy of the nervefibers. Such a relationship between the nerves and the blood vesselswould also be a great challenge to the neurosurgeons, because classicvascular decompression is impossible in such cases. EXAMINATION OF VACCINATION AGAINST INFLUENZA AT ELDERLY
Filareti Nalbanti, Evgenia Stavrakaki, Vasiliki Demertzidou Health Center of Sidirokastro, Serres Objective of our paper was the listing of elderly people that were vac-cinated against influenza. Material and Method: Our material were 114 elderly people that visited the Health Center during 2003, filling in a questionnaire concerning thevaccination against influenza. The filling in of the questionnaire wascompleted by the presence and the assistance of the present doctor. Results: Among the 114 persons of random samples of our study, 76(68,4%) were women and 38 (31,6%) were men. 80 persons (70,1%)were vaccinated at the drugstore, 21 (18,4%) at the Health Center and13 (11,4%) by individual doctors. Concerning their history that wasrelated with their protection against influenza, 16 (14,03%) were vac-cinated for the first time, while the rest of them are vaccinated everyyear. They were informed and advised about the protection againstinfluenza by the mass media, by the pharmacist of their neighborhood,by their acquaintances and friends and barely by the medical and non-medical staff of the Health Center. Results: We estimated that the need of a vaccination against influenzato persons of increased dangers is indisputable, the informing of thepeople belonging to a health center is permissible, independently of thesource, however, in collaboration with the family and other doctorsthat staff it. The objective is to decrease the complications of influenza in persons of increased danger. COMPLIANCE OF OVERWEIGHT HYPERTENSIVE PATIENTS AFTER
SUGGESTION FOR LOOSING BODY WEIGHT
Filareti Nalbanti, Eygenia Stavrakaki, Vasiliki Demertzidou, EleftheriaKapsali Health Center of Iraklia, serres The objective of the present study was the recording of overweighthypertensive patients after suggestion for loosing body weight. Material – Method: The material of the study consisted of 64 over-weight hypertensive patients that were selected at random in one of thesurgeries of general medicine, to whom, after the first visit to the anti-hypertensive surgery, in the frame of non- pharmaceutical interven-tion, it was suggested to follow a diet on low calories, simultaneouslywith the known suggestions for changes in the way of life (gymnastics).
The patients were weighed at each visit, being also measured for theirarterial pressure and the values were recorded. Results: Among the total of overweight hypertensive patients, 28 ofthem (43,7%) lost significant body weight during the 6 months on lowcalorie diet that was suggested and with physical exercise 3 – 5 timesweekly that was also suggested. At 32 (0,5%) patients existed no orminimal loss of their body weight, while 4 (6,2%) patients showed stag-nation or even increase of their body weight. Conclusions: A statistically important percentage complied with thesuggestion to loose weight. A small percentage complies difficult andit henceforth remains to us as doctors to insist more on this objec-tive for loosing weight, and as is it well known to us, that it involvesimportant reduction of arterial hypertension, and, consequently, bet-ter quality of life. COMMON ACUTE OR CHRONIC DISEASES OF THE RESPIRATORY
SYSTEM OF CHILDREN AND THEIR RELATION WITH THE SMOKING
OF THEIR PARENTS
Stavrakaki Eygenia, Nalbanti Filareti, Kapsali Eleftheria, DemertzidouVasiliki, Paspatis Grigorios GENERAL HOSPITAL OF SAINT NIKOLAOS, HERAKLION, CRETE Passive smoking in small children is incriminated for the increased fre-quency in common and chronic diseases of the respiratory system. Objective: to study the relation of adult parents of small children withsmoking and to locate the frequency of common diseases of the respi-ratory system in children with parents that smoke, and furthermore inchildren with parents that do not smoke. Material and Methods: A random sample of 188 small children, Thesmoking habits of parents before pregnancy and after childbirth wereexamined. The children that were hospitalized or examined for dis-eases of the respiratory system were found and their presence with thesmoking of their parents was connected. Results: Among the 188 parents, 85 mothers (45,2%) and 118 fathers(62,7%) were smokers before childbirth. The pregnancy and the child-birth modified very little the habits of smoking. Only 10 mothers(11,7%) discontinued smoking and 12 (10,1%) modified considerablythe habits of smoking (4 of them discontinued smoking and 8 of themsmoked outside the house). Among the 188 children, 48 were hospi-talized or examined for diseases of the respiratory system, amongwhich 14 (29%) had non-smoker parents and 3 of them suffered frombronchiolitis, 5 from asthmatic bronchitis, 3 from laryngitis and 3 frombronchopneumonia. The other 34 children (71%) had parents thatsmoked and 10 of them suffered from bronchiolitis, 9 from asthmaticbronchitis, 4 from laryngitis, 8 from bronchopneumonia and 3 fromchronic rhinitis. Conclusion: The children that are passive smokers present more thandouble danger for common diseases of the respiratory system in com-parison with the children that their parents do not smoke. Most dis-eases have a chronic character and their natural development is influ-enced unfavourably by smoking. This fact should particularly bestressed to the parents that bring for the first time their children forexamination and present respective problems of the respiratory sys-tem, aiming to the change of smoking habits. DOES IMPROVEMENT IN PSYCHOPATHOLOGY CORRELATE WITH
IMPROVEMENTS IN HEALTH RELATED QUALITY OF LIFE AMONG
PATIENTS WITH SCHIZOPHRENIA? RESULTS FROM THE SQUARE
Christodoulopoulou A, Karokis A, Yfantopoulos J, PapagiannopoulouV, Angelopoulos N, Gourzis F, Ioannidou I, Karavatos A, Lagari V, Lym-beraki G, Panagoutsos P, Papadaki N, Stathakis I, Tzanakaki M, Vla-haki K and V Mavreas - on Behalf of the SQUARE study Group.
OBJECTIVES: Evaluation of schizophrenic patients requires measure-ments that extend, beyond mere estimation of psychopathology symp-toms, to assessment of quality of life levels. The relationship betweenpsychopathology and HRQOL changes has not been extensively stud-ied. The objective of this study is to assess correlations between psy-chopathology (Positive and Negative Symptom Scale, PANSS) and a dis-ease-specific questionnaire, the Quality of Life Scale (QLS), in the eval-uation of schizophrenia patients.
METHODS: An open-label, 52-week follow–up study of 170 patients isbeing conducted in 8 Greek public psychiatric hospitals. Patients withmild to moderate schizophrenia (according to DSM-IV criteria) aged 18-65, hospitalized or outpatients, newly diagnosed or in acute exacerba-tion were enrolled. Psychopathology was assessed by PANSS generalpsychopathology, positive and negative symptom scores. HRQOL wasassessed by QLS total and 4 subscale scores (interpersonal relation-ships, instrumental role, intrapsychic foundations and commonobjects and activities). Correlations analysis was used to identify therelationship between PANSS and QLS scores at baseline and at stabi-lization after 6-months treatment. Six month follow-up data are pre-sented in this analysis. RESULTS: At baseline, a weak but statistically significant (p<0.001)association was found between the 4 QLS subscale scores and PANSSgeneral and negative symptom scores. Correlation coefficients rangedfrom r=-0,18 (p<0,05) (QLS instrumental role vs. PANSS negative) to r=-0,46 (p<0.001) (QLS intrapsychic foundation vs. PANSS negative). Atsix months a stronger and statistically significant association wasobserved. Correlation coefficients ranged from r= - 0,32 (p<0.001) (QLStotal score vs. PANSS general) to r= -0,56 (p<0.001) (QLS intrapsychicfoundation vs. PANSS negative). CONCLUSIONS: The study reveals a statistically significant correlationbetween PANSS and QLS at baseline scores, which is improved overthe 6-months follow-up period. HRQL measures and psychopathologyseem to change synchronically; the correlation is enhanced as the con-trol of schizophrenia symptoms is improved.
THE RELATION BETWEEN DISABILITY AND HRQL AMONG PATIENTS
WITH SCHIZOPHRENIA: CORRELATION BETWEEN WHO-DAS II AND
Christodoulopoulou A, Karokis A, Yfantopoulos J, PapagiannopoulouV, Gamvroula K, Georgiadis M, Gourzis F, Kafantari A, Kallinis Ch,Lavrentzou E, Mavridou E, Mouzas O, Spanou A, Tsirkas Ch, YfantisA and V Mavreas - on Behalf of the SQUARE study Group.
OBJECTIVES: A shift of interest from symptoms control to theimprovement of the quality of life, functioning and disability of patientswith schizophrenia is recently observed. This study aims to evaluatethe relationship between quality of life and disability, correlating theWorld Health Organization Disability Assessment Schedule (WHO-DASII) with a disease-specific questionnaire, the Quality of Life Scale (QLS),in patients with schizophrenia.
METHODS: In an open, 52-week duration study in 8 Greek psychiatrichospitals, 170 patients diagnosed with schizophrenia (DSM-IV crite-ria), hospitalized or outpatients, newly diagnosed or in acute exacer-bation were assessed at baseline and 3, 6, 12 months. Correlationsanalysis was used to identify the relationship between WHO-DAS IIand QLS sub domains scores. Baseline and 6-month follow-up dataare presented in this analysis. RESULTS: The statistically significant correlation between WHO-DASII Relations with others with QLS Interpersonal relations and Intrapsy-chic foundations domains at baseline became stronger at 6-months(r=-0.309, -0.269 vs. -0.479, -0.384, p<0.01). WHO-DAS II Social par-ticipation was significantly correlated with QLS Interpersonal relationsand Intrapsychic foundations domains only after 6-months follow-up(r=-0.055, -0.084 vs. -0.322, -0.244, p<0.01). The baseline significantcorrelation WHO-DAS II Activities of daily life and QLS Commonobjects and activities was expectedly not significant at 6 months (r=-0.496 (p<0.01) vs. -0.120). CONCLUSIONS: Quality of life in schizophrenia is correlated withpatients' functioning and disability in some but not all domains. Thisis due to the fact that disability and quality of life represent overlap-ping but not identical concepts. Both types of instruments togetherwith psychopathology measures, should be used for a comprehensive assessment of the health state of patients with schizophrenia. QUALITY OF MEDICAL PRACTICE ON A GUNBOAT OF THE
Konstantinos Paschos Ex seaman physician of a Hellenic navy gunboat, ThessalonikiGR 54250 Greece Medical professionals on Hellenic navy gunboats are physicians whoserve their military service.
MATERIAL &METHODS: The gunboat of this study is a warship whichpatrols the Northern Aegean Sea. The crew consists of 65 members, 18to 35 years old, officers, petty officers and seamen. The medical prac-tice is evaluated according to available medical equipment and instru-ments, the ship's medical ward, the conditions of medical practice, thephysician's other tasks which affect his ability to examine and cure,the patients' compliance.
RESULTS: The medical ward is a small cabin inappropriate for medicaluse. The equipment is adequate for primary health care. The patients'compliance is low due to inebriation or numerous tasks that they mustaccomplish even if they are sick. The physician is a multi task seaman.
In voyages with wind speed 6 Beaufort or more, moving or working intothe ship is almost impossible.
CONCLUSIONS: Exercising the medical profession as a conscript sea-man on a gunboat is difficult, sometimes impossible. During a storm ora gale medical practice becomes impossible. The patients don't fullycomply with the physicians advice. The quality of medical practice is low.
TELEVISION AND QUALITY OF LIFE OF CHILDREN
Sofia Alevras-Kokkali, Ioanna Karadonta, Argyroula-Vasiliki Karadon-ta *, Ioanna Agorogianni-Tsami Pediatric Clinic General Hospital Larissa Television constitutes a reality in the children's life. Its effect in thequality life of children is big, the free time of children is limited, isadopted and sedentary way of life Our aim was to record the effect of television in the quality of chil-dren's life, the attitude and the intervention of parents in the follow-up of television programmers. Our material was 216 parents and children's interviews from 6 to14year old that arrived in our clinic. The information we collected wasthrough a questionnaire that included questions, with regard towhether the parents select the television as medium that providedentertainment useful information's if there is a television in chil- dren's room, and how many hours children study, play and watch TVmoreover, parents were asked if they check the programmers theirchildren watch on TV, if their children imitate the heroes in somemovies, if parents use the television to have their children occupiedat home.
Results 78% of parents used the television as medium of entertain-ment, 27% of children had television in their room, 58% of childrenthey read daily 4to 4, 5 hours, 54% dealt with out of school activities2 hours daily. Children from 6-10 year old watched television pro-grammer 3-3, 5 hours daily, and children from11-13 years old whowatched television 1-1, 5 daily prefer dealing with social and schoolactivities. 7% of children who watched television more than 4 hoursdaily resulted in an increase in their weight and were not active andenergetic. The imitation of heroes in movies was important 81% of parentschecked the programmers their children that watched, 57% of parentsused the television to have their children occupied at home.
Conclusion: Television influences the quality of children's life, limitschildren's free time, the time they need to study ,play and do out ofschool activities which are useful for children's proper, physical and ILLNESS Von-WILLEBRAND AND QUALITY of LIFE
Sofia Alevras-Kokkali, Ioanna Karadonta, Argyroula-Vasiliki Karadon-ta *, Ioanna Agorogianni-Tsami Pediatric Clinic General Hospital Larissa Von – Willebrand's disease is a hereditary and haemorrhagic one.
Our aim work is to investigate the quality of a child's life who is suf-fering from von-Willebrand'disease.
Our material was the oral interview of 7 year old boy suffering fromvon – Willebrand's disease that arrived in our clinic. Result: The child had intense automatic nasalhemorrhage that wefaced with success.Th ediagnosic of illness became is during the infan-tile age. The child had an intense fear for a new bleeding and was sadfor the restrictions that were imposed to him, so that doctor couldcheck the illness.He was also afraid of being rejected by his classmatesfor by any chance his reject because of his illness. The child because of his age did not understand the restrictions wereimposed thing to him and this made him particularly uneasy. Thechild had intense dependence on his parents because he presentedregression in previous stages of growth.His parents reported that theirchild presented nightmares during the sleep and nightly enuresis afterhaemorrhagic episodes. His school record was quite good. The child was social and had friendsHe also liked listening to music and used his computer in his freetime.
Conclusion the pediatrician should support psychologically both thechild and his parents and explain simply to the child the particular-ity of his illness the reason why he should be careful while playing andavoid certain sports so that he does not feel that the restrictionsimposed are punishment.
QUALITY OF LIFE OF CHILDREN WITH THALASSEMIA
Sofia Alevras-Kokkali, Ioanna Karadonta, Argyroula-Vasiliki Karadon-ta *, Ioanna Agorogianni-Tsami Pediatric Clinic General Hospital Larissa Thalassemia is a chronic disease that for its successful confrontationis required except the medical care and psychological support ofpatient. The aim of our work was to study the quality of children's life with Tha-lassemia. Material method constituted oral interviews of 8 children, age of 6-12years that suffered from Thalassemia and were visited our clinic.
Results: All the 8 children were informed for their disease and for itsparticularities. All the children asked to learn information on their dis-ease from their parents or their doctor, while the 3 children that wereover 8 year old knew enough details so much for their disease as longas for the transfusions and for the overnight subcutaneous issuing des-ferioxaminis that they are submitted. The children over 8 year old hadrealised that their schoolmates are not submitted in transfusions andthis had created them feelings of inferiority while they are afraid of anychance rejection because of their disease from their scoolmates. From 5 of the children their parents reported disturbances at the sleepwith nightmares and nightly enuresis mainly afterwards the transfu-sion. All the children felt intense fear and stress for their disease. In allthe children was observed intense dependence from the parents as wellas the parents were overprotected opposite to them. Nevertheless thechildren were social and had friends. Records in the school in 6children were very good while in other 2 chil-dren mediocre. Neither one of the children did not deal with the sports. All the children had satisfactory pastime with other out of school activ-ities as music, learning of foreign languages, e.t.c. Conclusion: The child understands much more things than we believefor his her disease.The pediatrician should explains to the child in asimple way the nature of disease and attends for the right psychoso-cial development of child.
BRONCHIAL ASTHMA IN THE CHILDREN OF ALSO QUALITY OF LIFE
Sofia Alevras-Kokkali, Ioanna Karadonta, Argyroula-Vasiliki Karadon-ta *, Ioanna Agorogianni-Tsami Pediatric Clinic General Hospital Larissa Bronchial asthma is chronic pneymonopathy that is due to hyperac-tivity of bronchus and varied degree stenosis of bronchus that recedeseither automatically or afterwards the use of brochodicator. The aim of our work was to investigate the quality of life of asthmaticchildren.
The material-method constituted 130 oral interviews of known asth-matic children who arrived in our clinic From these the 62 were boysand the 68 girls, age of 6-12 years. Results In the children it was observed in the 98% intense stress andfear for a new asthmatic crisis. The 93% of children are ashamed forhis/her disease while the 89% are afraid of any chance rejectionbecause of their disease from their schoolmates. The 89% are worriedfor the restrictions that are imposed to them to be checked the disease. In the asthmatic children were observed disorders of behavior, moreanalytically: in the 75% regression in previous stages of development,in the 85% intense dependence from their parents, in the 66% thechildren are shy in comparion with schoolmates their. In the 62% ofthe children reported alleviation of the initiatives and their activitiesbecause of the fear of a new asthmatic crisis. While after the adviceby the pediatrician the 86% of boys and the 74% of girls deal with thesports at least two hours weekly. The 78% over 8 years asked to learn information about their diseasesfrom their parents or the doctor. Conclusion: bronchial asthma influences unfavourably in sentimentalmaturation and mental development of child. Essential is the rightbriefing of so the parents child himself /herself for diseases point outthat the children's asthma has good forecast and we provide constantsentimental support ATTITUDE OF SOCIETY OPPOSITE IN THE EPILEPTIC CHILD AND
THE EFFECT IN HIS/HER QUALITY OF LIFE
Sofia Alevras-Kokkali, Ioanna Karadonta, Argyroula-Vasiliki Karadon-ta *, Ioanna Agorogianni-Tsami Pediatric Clinic General Hospital Larissa Epilepsy (E) is a disease that is usually expressed with disturbance ofconscience and is accompanied by abnormal moving phenomena andis due to functional disturbance of teams of neurons of brain. Its beginning usually becomes in the children's age. The aim of work was to study the opinions of society opposite to theepileptic child The material of work constituted 425 interviews of parents of notepileptic children that visited our clinic. The parents were categorizedat educative level, professional activity. The 22,5% were graduates ofLyceum, 31% of superiors, 28% of Universities ,to 18,5% had elemen-tary education. The 3% of parents dealt with professions of health. The results from the 425 parents the 18% had seen individual inepileptic crisis, the 26% knew what means E, to 5% knew how help aindividual with convulsions. The 39% considered that the childrenwith epilepsy present mental decline over while the 42% consideredthat they have aggressive, antisocial behavior,to 55% they believedthat have decreased record in the school obligations, 38% consideredthat they should not participate in athletic activities. The 19% wouldworry if his/her child had contanct with epilepcie child and the 5%would try him/her remove from this. The 98% believed that the teach-ers should be informed if it exists in the school child with E and haveknowledge about the disease. Conclusion the epileptic child in his effort to include himself/herselfin the society is faced with bias many times which is due to insuffi-cient or erroneous briefing. More knowledge for the E had the individ-uals that in their environment existed individual with the disease orthey had a profession of health. It should become health briefing ofpopulation for the disease so as to become acceptable as any otherchronic disease. SPORTS AND QUALITY OF LIFE IN STUDENTS IN PUBLIC
INSTITUTIONS OF EDUCATION
Sofia Alevras-Kokkali, Ioanna Karadonta, Argyroula-Vasiliki Karadon-ta *, Ioanna Agorogianni-Tsami Pediatric Clinic General Hospital Larissa The pastime with the sports contributes in the maintenance of the bod-ily well-being of person and his psychosocial balance The aim of our work was to record the athletic activity with regards tothe free time and the effect in the quality of life in students of Publicinstitutions of education(IEK) Material – method: the information were collected after distribution ofquestionnaire in 142 students, from which the 75 were men and the67 women of age of 19 to 25 years. The 40% of female students report-ed the work simultaneously with their study, the 6% were married. The95% of total female student reported that they consider the pastimewith athletic activities important . The 71% had intention to exercisedbut have no free time while the 41% dealt with athletic activities. Thesports that they preferred were dance 38%, aerobic 28%,swim-ming18%, volleyball 10%, 6% other sports. With the exercising dealt1hour weekly the 22%, 2 hour weekly the 50%, 3 hours and more 28%. As for the place of exercising, the 62% were in gym, the 28%alone, 10% in other places. Respectively the male students answered: the 67% worked, to2% weremarried . The 89% believe that the pastime with athletic activities isimportant in the human the 86% had intention to be exercised sys-tematically but they have no free time, while the 69% are exercisedstudents dealt with the football the 45%, basketball 28%, volleyball the18%, 9% with other sports. As for the place of exercising, the 48%areexercised ,to 42% in gym, 10% in other places. Conclusion the males and female students because that at the sametime with the studies have family and professional obligations do nothave enough time to deal with the sports T∏∂ EFFECT OF COMPUTER IN THE QUALITY OF CHILD'S LIFE
Sofia Alevras-Kokkali, Ioanna Karadonta, Argyroula-Vasiliki Karadon-ta *, Ioanna Agorogianni-Tsami Pediatric Clinic General Hospital Larissa We live in the season of rapid growth of technology,which has becomeintegral part of the daily life. The presence of computer (PC) is espe-cialcy intence. Aim of our work was to record the effect of PC in the quality of life ofchildren, the opinions and the attitude of children and their parents.
Material-method constituted oral interviews of 280 children of schoolage and their parents that visited our clinic from these 151 were girlsand the 129 were boys of age 6tof14 years. Results of the 78% of children have used PC, the 57% have PC in thehouse while the 32% have connection with internet. They deal with thePC one hour every day the 38% of children, 2hours the 42%, 3 andmore hours the 20% .At weekends the time is doubled. The childrenthat deal with PC 3 and more hours don't deal with natural activities,and increased bodily weight. The children in the PC play electronic games the 35%, write12%, paintthe 8%, deal with internet 25%. The parents watch the children the hour of handling PC in the 46%,rebuke them from the 65% from fear for their health (ophthalmic,damage, epilepsy, radiation), in the 35% because they don't study les-sons their courses, in the 24% because they do not play neither theyare exercisedThere is not any difference between two with regards to their use. Conclusion big percentage of children deals with use PC, for the rea-son that the parents and teachers should be informed in the subjectsof modern technology. The free time of child is limited against the bod-ily exercising,team games, reading of literary books. The older childrenhave more often PC in their home and they are familiarized with theits use. The Pediatrician should inform the parents and the childrenfor their right use. The PC should be in place where the parents cancontrol the children at their use.
NONFINANCIAL MEASURES OF PERFORMANCE IN GREEK PUBLIC
Sofianou, L. MBA and Baralexis S. PhD, Ass. Professor Department of Accounting and Finance, University of Macedonia540 06, Thessaloniki, Greece Objective: The objective of the study was to examine the use of nonfi-nancial measures of performance in Greek public hospitals.
Method: The study was conducted by means of a)semi-structuredinterview & b)questionnaire. To this end, 20 physicians were inter-viewed, as well as, the administrative personnel of 4 Peripheral Sys-tems in Healthcare(Pe.S.H). The questionnaire was sent by fax and e-mail to all Pe.S.H, in total 17, in order to be answered by the hospitalsunder their management, in total 132. The 38 indicators used in thequestionnaire were selected from the existing literature (e.g. the U.S.A.
and the U.K.) and were divided into 3 categories: 1)General Indicators2)Nosocomial Indicators 3)Indicators at the ER.
Results: 72 hospitals replied out of 132. The results obtained showthat hospitals measure (frequently or periodically) the length of stay,occupancy rates, staff availability, nosocomial infections, inpatient andneonatal mortality. The indicators concerning number of complaints,patient’s likelihood to recommend hospital, patient and per-sonnel satisfaction, readmission rates, management of labour, daysfrom mammogram to biopsy, cancellation of day case procedure on theday of procedure, unplanned returns and registered time to the ER,adequacy of information supplied to families of ER patients were sys-tematically measured by 18%, 3%, 7%, 17%, 25%, 54%, 3%, 23%,23%, 18%, 31% of the sampled hospitals respectively. The quality oflife index, medication error rates, use of physical restraint and fallswere indicators sporadically measured.
Conclusion: The study has shown that the most frequently recordedindicators by hospitals arise from data, the collection and process ofwhich do not require a great deal of effort. On the contrary, the meas-urement of more specified indicators, which require the implementa-tion of specific assessment frameworks, is more rare. The small per-centage taken regarding the use of some indicators seem to supportthe argument that some hospitals have not grasped the significance ofnonfinancial measures of performance.
THE TRANSFORMATION OF THE REQUEST: A CASE STUDY OF A
SHORT TERM FAMILY THERAPY
Bourboulas Th.1, Papadopoulou Vas.1, Zeis Fr.2, Christianopoulos Kr.1 1Psychiatric Department for Children and Adolescents of "Hippokratio" Gen. Hospital of Thessaloniki 2D' Axis of Psychiatric Hospital of Thessaloniki This poster presents a case study of a short-term family intervention regarding a divorced mother and her adolescent daughter who was suf-fering from epileptic seizures.
The emphasis is placed on the transformation of the mother's initialrequest, that her daughter collaborates with a Neurologist to receivemedical treatment. The day before the first personal interview with the daughter, a familycrisis had arisen that had led the mother to ask for help from the ther-apist in order to be able to face this particular event and generally tocope with everyday difficulties in communicating with her daughter.
To achieve this, a short course of five sessions of Family therapy wasarranged for mother and daughter. At the end of the last session it was announced to the therapist thatthe daughter had accepted an appointment with a Neurologist.
The essential point is that the initial request (considering the medicalproblem of the daughter) was finally satisfied without any "problem-solving" technique, or any direct intervention or even discussion onthis particular issue since the therapeutic attempt during the familysessions was focused on the everyday difficulties between mother anddaughter and this case study intended to raise the item of ‘transfor-mation of the request' during a therapeutic intervention. HOSPITALIZING CHILDREN AND ADOLESCENTS WITH MENTAL
RETARDATION IN A ‘CLOSED' PSYCHIATRIC DEPARTMENT
Ekonomou An. Bourboulas Th. Christianopoulos Kr. Psychiatric Department for Children and Adolescents of "Hippokratio"G.H. of Thessaloniki This ‘poster' presentation, represents a retrospective study, considerof fifty (50) cases, children and adolescents with M.R. –alreadyknown or first diagnosed – who have been hospitalized in our depart-ment, for a variety of reasons, during the period from 2000 to 2003,among 237 other cases during the same period.
The purpose of this study was to consider a variety of parameters,such as the causes and reasons that had led those kids for hospital-ization, the possible coexisting conditions on the different Axes ofDSM-IV and the subsequent differential-diagnostic problems andalso the outcome or the need for medication.
The method was the retrospective study of the medical files of thesecases, using basic statistical analysis and the main results are meetas follows:The ascertainment of M.R. have first been realized during the currenthospitalization, for about the half of the cases, wile the most commonreason for joining the department was ‘behavioral disorders' ( 60%)with prevailing the ‘disruptive' ones.
Another main result was the appearance of high proportion ( 75%) ofcoexisting psychopathology on Axis-I, that was complicated the diag-nosis and treatment as well. There was also found a significant prevalence ( 40%) of ‘generalmedical conditions' (Axis-III) but very few of theme where found torelate –directly or indirectly- with the Mental Retardation.
The need for psycho-pharmacological medication was proved about40% in general, and considered mainly -but not exclusively- thecases with co morbidity. Regarding the outcome, it could be characterized ‘at least wellenough' or better, in a proportion about 60%, with or without med-ication.
At last –but not least- is specifically notable the fact that a high pro-portion of those kids, were living or stemmed from ‘low' ( 35%) or‘very low or multi-problematic' ( 35%) socio-familiar environment.
The main conclusions of this study could be summarized as follows: i) The basic reason that leads a child or an adolescent with M.R. for hospitalization is the ‘disruptive behavioral disorders'.
ii) Behavioral disorders of other types (i.e. avoidance or disorganiza- tion) often indicate coexisting psychopathology on Axis-I, which–in this study- was found particularly high according the interna-tional literature.
Specifically high was found, the proportion of low socio-familiar levelof those kids who have been studied and this serious fact indicatesthe need for a variety of out-hospital structures and communityservices.
MAIN CARDIOVASCULAR RISK FACTORS FOR ACUTE MYOCARDIAL
INFARCTION AND THEIR CORRELATION WITH AGE
V.Karaghiozaki, L.Borghi, S.Terzi, A.Gotsis, M.Pasalidou, S.Xaritos,I.Litsas, I.Koukoutsis, T.Tsaraktsidou, D.Xatzigeorgiou,O.Koutso-giannis.
Health Center of Iasmos –Greece Objectives: It has become increasingly clear that the majority of acutecoronary events occurs in indivinduals with traditional risk factorssuch as hypertension, dyslipidemia , diabetes mellitus type II(DM), cig-arette consumption and family history.The aim of the study was toevaluate the main cardiovascular risk factors in patients with acutemyocardial infarction(AMI) and to estimate if there is any correlationbetween them and the parameter of age. Design and methods:In our study were enrolled 151 patients withmyocardial infarction, 86 men (56 Muslims and 30 Cristians) and 65women (36 Cristians and 29 Muslims) having mean age of: 65,3_+12years, who had got the first aid in Health Centre of Iasmos beforetheir admission to Coronary Unit of Hospital of Komotini, during theperiod 1994-2003. Besides hypertension, other risk factors such assmoking, dyslipidemia, diabetes mellitus type II, family history andprevious history of ischemic heart disease have been taken intoaccount. Results: To start with, the mean values of Systolic and Diastolic bloodpressure were: 166,3 ±13,5 mmHg (p<0,01) and 92,1 ± 7,9 mmHg,(p<0,001). Hypertension was present in 79,1% of patients with meanage :63,5±13,7years, p<0,001, whereas dyslipidemia was observed in82,7% of cases with mean age 67±12,4 y., p<0,001.Moreover, 76% ofpatients were cigarette smokers (mean age: 51,23±12,5 y., p<0,001)and 65% of them were diabetics (mean age 45±11y.).Finally, 74,2% ofindivinduals had family history of CAD (mean age: 38±10,2 y.,p<0,001) and 63% of the patients had a previous history of CAD (meanage: 60±13,2y.) Conclusions: Our findings indicate that hyperlipidemia and secondar-ily hypertension prevail as main risk factors for ACI. Moreover, thecontribution of family history and DM as risk factors to ACI is greaterin younger patients whereas hyperlipidemia and hypertension pre-vail in older ones.
THE EVALUATION OF ANTIHYPERTENSIVE TREATMENT IN PRIMARY
V. Karaghiozaki, L. Borghi, S. Terzi, A. Gotsis, M. Pasalidou,I. Koukoutsis, I.Litsas, St.Xaritos T. Tsaraktsidou, O. Koutsogiannis.
HEALTH CENTER OF IASMOS - GREECE Objective: The aim of this study was to evaluate the therapeutic man-agement of hypertension in patients who were followed in Hyperten-sive Outpatients' Unit of Health Centre Of Iasmos, during the period1997-2004.
Methods: We examined 1834 patients with essential hypertension (1125 Muslims and 709 Cristians), including 806 women (405 Mus-lims and 401 Cristians) and 1030 men (720 Muslims and 310 Cris-tians) with mean age : 65,1±12,3years.The various classes of antihy-pertensive agents were estimated and their proportion was calculated.
Results: Of the total, antihypertensive therapy was prescribed in91,9% of hypertensives and 27,9% received monotherapy.On the scopeof monotherapy, angiotensin converting enzyme inhibitors (ACEIs) aregiven in a proportion of 28% whereas calcium antagonists (CA) areused in 25% of the cases, diuretics in 20%, beta-adrenoceptor antago-nists (BB) in 17% ones, angiotensin II receptor antagonists (ARBS) in8% and a-adrenergic receptor antagonists in 1,5% ones.
On the scope of combination of antihypertensive agents, ACEIs withdiuretics are used in 40% of the cases, ACEIs with CA in 15%, ACEIswith CA, BB and diuretics in 15% ones, ACEIs with BB and diureticsin 28% ones and CA with BB in 2% of cases. Conclusions:These data indicate that the ACE inhibitors are more fre-quently used as monotherapy for antihypertensive treatment in pri-mary care whereas their combination with diuretics is prescribedmore often in comprison with any other combination of antihyperten-sive agents.
IMPROVEMENT OF UREMIC SYMPTOMS IN ANURIC PERITONEAL
DIALYSIS (PD) PATIENTS AFTER INCREASING DIALYSIS DOSE
Liakopoulos, V.1, Stefanidis, I.1, Krishnan, M.2, Oreopoulos, D.G.2 1Department of Nephrology, Medical School, University of Thessalia,Larissa, Greece and 2Division of Nephrology, University Health Net-work, University of Toronto, Toronto, Canada Increment of PD dose prescription, in clinical practice, is dependent onthe presence of symptoms and/or laboratory findings indicating ure-mia. The scope of the present study was to evaluate the effect ofincreasing the dialysis dose on the prevalence of uremic symptoms inPD patients. We retrospectively evaluated all anuric patients of our PD program, inwhom the dialysis dose was increased during the last five years. Werecorded data for fatigue, anorexia, insomnia, pruritus and nausea,urine and peritoneal clearances, serum creatinine, BUN, PO4, Hb, EPOdose, blood pressure and weight for a period 6 months before and 6months after the change in PD prescription.
44 anuric PD patients (19 males, mean age 52±16 years) were regis-tered (37 on CAPD, 7 on APD). Mean duration of PD before the changein dialysis dose was 27.8±18 months. Daily dialysate volume wasincreased an average of 2.2 L in CAPD and 4.3 L in APD patients. Peri-toneal Kt/V and weekly creatinine clearance increased from 1.91±0.24to 2.44±0.47 and from 48.6±8.1 to 61.2±11.6 L/week respectively. Theprevalence of fatigue decreased from 80% to 38%, anorexia from 50%to 20%, insomnia from 45% to 11%, pruritus from 34% to 9% and nau-sea from 11% to 4%. All changes were statistically significant. In conclusion, after a little over two years on PD most anuric patientsdevelop uremic symptoms. Fatigue is the most common symptom fol-lowed by anorexia. An increase in the dialysis dose leads to a decreasein the prevalence of all the symptoms and an improvement of thepatients' quality of life. Such an increase in prescription should beconsidered if PD patients become symptomatic.
MEDICAL TREATMENT OF PATIENTS WITH HEART FAILURE DURING
THE LAST THREE YEARS
Borghi.L, Alexoudis.A, Karali.A, Passalidou.M, Stilidou.V, Xaritos.S,Gotsis.A, Terzi.S, Koutsogiannis.O Health Center of Iasmos Rodopi, Sector: INTERNAL MEDICINE Purpose: The aim of this study was to valuate if medical treatment ofheart failure in our health center, aimed mainly to reduce relativesymptoms and total mortality, was in accord with the official European Guidelines 2001 for the treatment of heart failure.
Methods: The medical therapy was registered in 368 consecutivepatients (mean age 65±14 years) with diagnosed heart failure and whowere seen in the emergency or outpatients' department of Iasmos. Thispopulation was divided in two groups, Christians and Moslems.
Results: The following table shows the results of the recording of themedical treatment to both groups.
ACE-I: angiotensin-converting enzyme inhibitor, AT-II: angiotensin IIreceptor antagonist, CHB: calcium-channel blockers, TD: thiazidediureticsConclusions: The most common prescribed drugs were loop diureticsand ACE-I. Spironolactone and b-blockers were used very less thanadvised in the European Guidelines in spite of their proven effect ontotal mortality and sudden cardiac death. STUDY OF THE CAUSATIVE FACTORS OF ACUTE PANCREATITIS
Alexoudis.A, Borghi.L, Kessidou.N, Karali.A, Passalidou.M, Stilidou.V,Kessidis.V, Koutsogiannis.O Health Center of Iasmos-Rodopi Objective: Acute pancreatitis is a very serious and life-threatening dis-ease. The purpose of our research was the recording of patients withacute pancreatitis and the study of the causative factors of this dis-ease.
Methods: during the last three years were studied 33 patients (pts), 21females (mean age 45±15 years) and 12 males (mean age 57±12 years).
These patients came to our Health Center referring abdominal painduring the early hours in the morning. The diagnosis was based on thesymptoms and clinical signs, the personal medical history, the abdom-inal ultrasound scan and serum amylase level and other baselineinvestigations included a full blood count, urea and liver biochemistry.
Cholesterol and triglycerides were also calculated. In all patients wereeffectuated the conventional measures: a) analgesics, b) intravenous fluids and colloids, c) nasogastric suction and they transported to thenearest hospital.Results: The mean value of serum amylase was 1260U/L. Gallstones were individuated in 25 patients. Fatty liver was foundin 3 pts, hyperlipidemia in 33 pts and chronic alcoholism 8 pts. Themost patients had more than 2 causative factors. Five patients, withpersonal history of coronary disease, had new onset ST-T changes inelectrocardiogram simulating myocardial infarction: in 2 pts ST eleva-tion in precordial leads and in 3 pts T wave isophasic in lateral leads.
Eleven patients had already had a very fatty meal. Conclusions: It is confirmed that the commonest factor of acute pan-creatitis are the gallstones (over 75%). Hyperlipidemia and fatty liverseem to be less important factors.
DISTRIBUTION OF CONCOMITANT DISEASES IN DIABETIC
Borghi.L, Alexoudis.A, Pasalidou.M, Karali.A, Metalidou.S, Kessidis.V,Kessidou.N, Koutsogiannis.O Health Center of Iasmos Rodopi, Sector: INTERNAL MEDICINE Purpose: to study the distribution and the relative prevalence of con-comitant diseases in patients affected by type 1 and 2 diabetes melli-tus in the last five years.Methods: 1619 diabetics came in our HealthCenter, 841 males (505 Christians and 336 Moslems) and 778 females(395 Christians and 383 Moslems), with mean age 65±25 years. Type1 diabetes had 321 males and 322 females. On the other hand, 520males and 456 females were affected by type II diabetes. In all thesepatients was considered the prevalence of the following concomitantdiseases: coronary heart disease, stroke, tumors, bleedings, foot ulcersand infectious diseases.Results: The following table shows the resultsof the recording of the concomitant diseases in the diabetic patients.
COPD: chronic obstructive pulmonary disease, RI: respiratory infec-tions, CHD: coronary heart disease, UTI: urinary tract infections, C:acute cholecystitis, P: acute pancreatitisConclusions: Diabetes mellitus seems to be an important risk factorfor infectious diseases, stroke and coronary heart disease, especially inmales. Moslem females suffer more frequently from CHD than Christ-ian females.
Gjencaj V., Caja T.
University Hospital Center "Mother Teresa" Tirana-Albania Professional Eczema occurs in work conditions by the action of diffrentfactors on the skin. It is chronic disease that deteriorirates the qualityof life.
Objective: To study the frequency and etiological factors of Profession-al Eczema in constractors, prophilaxi and treatment.
A total of 3221 patients with Eczema was examined, hospitalised dur-ing 1984-2003. 600 (19%) patients had Professional Eczema. 2502(87%) patients had eczema of the hands and antebrachiums.The mostfrequent causes for Professional Eczema were potassium bichromate,cobalt cholide, nickel sulfat. In 85% of the patients with positiveresults of the patch test. All the patients were treated with local andgeneral therapy. Resistent cases changed the work place, withoutchemical compounds. To continue work normaly we recomanded indi-vidual defensive measures during the work, defensive andepithelisive unguentum after the work.
We concluded that Professional Eczema is not rare (19%) in construc-tors. Development health prevention plays an important role in thecare of Professional Eczema and quality of life. LIFE QUALITY AFTER NON-TENSION INGUINAL HERNIA
Narbuts, Z., Ozolins, A., Gedins, M., Gardovskis J.
Department of Surgery, Riga Stradins University, LV1007, DzirciemaStr.16, Riga, Latvia Aim of study was evaluate and compare patient's life quality after fol-lowing non-tension inguinal hernia operations: Lichtenstein, totalextraperitoneal (TEP) and transabdominal preperitoneal (TAPP)herniorrhaphiesMaterial and methods: From December 2002 till February 2004 wereperformed 33 Lichtenstein, 33 TEP and 33 TAPP operations. Inclusioncriteria were: male patients, primary no complicated inguinal hernia,and age – 18 to 70 years. Median age of patients was 56 (20-70) years.
Patients fulfilled general SF-36 Short Form Health Survey and herniaspecific questionnaire before and 6 weeks after operation.
Results: Hospital staying time in Lichtenstein group was 4.4 days, TEP– 3.1 days, TAPP – 3.9 days. 6 weeks after operation in all groupspatients did not suffer from pain in rest position. 5 (15.1%) Lichten-stein group patients were edema in inguinal region 6 weeks after oper- ation, comparing in TEP and TAPP groups – no edema. 9 (27.3%) Licht-enstein group patients suffered from skin insensibility in inguinalregion 6 weeks after operation, comparing no skin insensibility in TEPand TAPP groups.
Short Form Health Survey SF36 demonstrated that life qualityimprovement was in all groups 6 weeks after operation but is differ-ence – after Lichtenstein and TEP operations life quality improvementis comparatively constant, in TAPP group it grows remarkable. Forexample, level in role physical (RP) category before operations in allgroups was around 40 points, 6 weeks after operation in Lichtensteingroup was 50, TEP – 68, TAPP – 94 points.
Conclusions: In all groups disappear pain in rest position. 15% Licht-enstein group patients had postoperative edema and 27% sufferedfrom skin insensibility in inguinal region 6 weeks after operation. Gen-erally patient's life quality improves after non-tension inguinal herniaoperations but the best improvement was in TAPP group.
THE MOTIVES FOR MEN TO PARTICIPATE IN FITNESS
I. Athanailidis1, G. Zarotis2, G. ªPOYZIKAS3, M. Proios4 1Department of Physical Education and Sport Science, DemoctirusUniversity of Thrace2Department of Primary Education, University of the Aegean3Municipality of Eleftherio-Kordelio, THESSALONIKI4ARISTOTELIS UNIVERSITY. OF THESSALONIKI Sport activity has been characterized as a multilevel psychological andsocial phenomenon as seen through the model developed by Kenyon(1968a,b). His research was based on the hypothesis that physical-sport activities can be divided into specific categories. Each of thesecategories seems to bring to surface a different source of satisfactionfor each person.
In order to measure attitudes towards physical activity, Kenyon dis-tinguished six scales of physical activity:i) "Social experience", that is, sport as a means of developing social rela-tions, ii) as "health and sport", that is, sport as a means of improvinghealth and acquiring a well built body, iii) as "risk search", that is, sportas a means of looking for opportunities to take risks, as iv) "aestheticexperience", that is, sport as a means for aesthetic pleasure throughbeautiful and harmonious movement, v) as "catharsis", that is, sport asa means of relaxing from stress, and vi) as "ascetic experience", that issport as a means to avoid "bad" habits through hard training.
In this paper we aim at tracing the reasons why men participate inphysical fitness programmes. These motives should be characteristicfor each age group.
Research was carried out in physical education and recreation centreswith a special interest in exercise and health, in Rhine-Westphalia (Germany). Interviewed people were persons registered as members inthese centers, as well as persons that attended the consultation ses-sion but did not registered. The total number of participants inter-viewed in this research was 3.248 persons, 1.889 of whom women and1.342 men; 17 of the interviewed did not answered regarding their sex.
All interviewees filled in a questionnaire including the following units:1) fitness/health, 2) appearance/body 3) psychical experience 4) cog-nitive aspect 5) social aspect 6) performance 7) movement aspect.
Data was analyzed through spss/pc*. The usual importance symbolswere used P <0.001, p<0.01, p<0.05, p>0.05 (Claus/Ebner 1985) forgrading importance.
The three main motives driving men per age group to participate in fit-ness programmes are the following:For men below 25 years of age, the main motive for their participationin fitness programmes is fitness/health (77.6 %), the second mostimportant motive is bodybuilding (69.3%) and the third most impor-tant one is programming and scheduling personal training 36%.
For men between 25 and 34 years of age, the two main motives are thesame as in the previous age group: fitness/health (82.3%) and body-building (51.9 %); a new motive is registered in this age group, and thisis counterbalancing work stress (46.6 %). In the age group 35 to 44 years of age, the main motive for male par-ticipation in fitness programmes is the same as in the previous groups(88.0%). Counterbalancing work stress is ranked second (63.2 %) whilethe third place is given to the wish to exercise and train in a pleasantand easy going way (53.1%).
As for the age group 45 to 55 years of age, the first motive is fitness/health (78.2 %), the second is the wish to exercise and train in a pleas-ant and easy going way (62.7 %) while the third reason why people par-ticipate in fitness programmes is slimming (fat reduction) (45.1 %).
CYBERSEX: A REAL DANGER IN A VIRTUAL WORLD
I.Tsikoulas, D.Zafeiriou, E.Doulianaki, M.Michaelidis, Ch.Digkas, N.Papakonstantinou, P.Antonopoulos, 1st Pediatric Clinic of Aristotele University of Thessaloniki Introduction: The quality of sexual life in adolescents is AZdeterminedby several behavioral patternsAim of this study is to analyze how deeply sexual relations of adoles-cents are affected by cybersex (= mutual masturbation in real time,using the medium of Internet, by typing highly erotic descriptions ofwhat they are doing to each other and to themselves)Material – Method: 474 high-school students15-18 years old (AV:16,6years) were asked about their preferences visiting Internet sites.
Results: 1) 67% of the students get daily into Internet. 2) 81,8% ofthem prefer chatting, every time they get in. 3) 56,7% of the studentsgetting into chat rooms, are looking for a heterosexual partner, where- as 7,73% for a homosexual one. 4) 31,9% of the chat room fans arehaving cybersex with anonymous partners. 5) 34,5% of them prefercybersex, without having any interest in real contacts.
Conclusion: Obviously, there is a great danger, that younger generationswill build up their sexual life in an electronical way, whereby replace-ment of real sex by online sex may affect the future reproduction rates.
UNPROTECTED CHILDREN AGAINST INTERNET THREAT
I.Tsikoulas, D.Zafeiriou, N.Papakonstantinou, Ch.Digkas, M.Michae-lidis, P.Antonopoulos, E.Doulianaki 1st Pediatric Clinic of Aristotele University of Thessaloniki Introduction: the interactive, electronic communication provided byInternet raised concern on its negative effects (increased violence,aggressive behavior, addiction to pornography, sexual perversion) uponteenagers. Aim of this study is to reveal the preference patterns to on-line pornography ( =adult and children images with violent, coprophilic,urophilic, necrophilic items) of adolescents while using Internet.
Material and Method: Anonymous questionnaires were filled in by jun-ior to senior high school students (14-18 years old)Results: 1)92% of the students are concentrated mainly on Internetviolent games. 2) 61,6% of them are highly interested in pornographicmaterial 3) According to users' opinion (72,9%) Internet provides adramatic privilege to the students: They can visit any kind of pornog-raphy sites easily, rapidly, secretly, without feeling ashamed of whatthey are doing. 4) In 84,4% cases, the parents seem to be unable totake under control their childrens' "electronic trips" . 5) 86,5% of thestudents experienced the unwanted, unexpected downloading ofpornographic files automaticallyConclusion: Teenagers' uncontrollable electronic exposure to violenceand pathological sexual standards may trigger children seduction orpornography. It is of great importance to protect our children from thisthreat, in order to provide quality in their sexual life and psychologicalsupport, when needed.
PHARMACOECONOMICS IN CLINICAL PRACTICE
Nowakowska E., Kus K., Richter P.S.
Department of Pharmacology, Karol Marcinkowski University of Medi-cal Sciences in Poznan, Poland, Rokietnicka 5A str., 60-806 Poznan,Poland Depressive illness places an enormous economic burden on the health service system, on the individual patient and the community. The arti-cle presents the rules of calculation of the costs of depression treat-ment. Cost reduction for the individual patient and the community(public health care system) is connected with applying rational andmodern pharmacotherapy.
The aim of the study was to compare therapeutic results, direct andindirect costs of depression based on CEA (cost effectiveness) analysis.
The research was conducted at the Department of Psychiatry of KarolMarcinkowski University of Medical Sciences. The outpatient groupwas made up of patients who were diagnosed with depression (ICD-10)and who continued their therapy after discharge from hospital in 1999.
Summary and conclusions. Because of the fact that the patients constitute a heterogeneous group(differing in age, sex, professions, salary) the indirect costs of depres-sion therapy can be evaluated only with some degree of approximity.
Despite the research imperfection (lack of possibilities to work out fullyreliable financial simulation) we can assume that the main goal ofdepression therapy should be the improvement of patients' standard oflife by making them more productive, reducing the risk of suicides, andreducing indirect costs of depression treatment. Depression therapiescost comparison allows us to come to the conclusion that indirect costsare a significant financial burden. The choice of therapy should not bebased on separate drug evaluation but on therapeutic benefits whichresult from its implementation. Feasibly chosen medical standards willmake it possible to reduce the therapy costs which should prove ben-eficial both to the patients and to the institutions involved in the ther-apeutic process.
MEDICAL TREATMENT OF THE ARTERIAL HYPERTENSION
Stylidou.V, Kessidis.V, Alexoudis.A, Borghi.L, Pasalidou.M, Zodou.G,Karali.A, Koutsogiannis.O Health Center of Iasmos-Rodopi, Sector: INTERNAL MEDICINE Purpose: determination of the epidemiologic characteristics of thearterial hypertension and the registration of the anti-hypertensivedrugs and their combinations used in clinical practiceMethods: 2328 patients were studied that came from the wider areaof our Health Center. They were registered according sex, religion,age, medical history, medical treatment and its effectiveness. As con-trolled blood pressure was considered the one with systolic pressure(SP) < 140mmHg and diastolic pressure (DP) < 90mmHg.
Results: Among the 2328 patients, 1536 were males (836 Moslemsand 700 Christians) and 792 were females (542 Moslems and 250Christians) and 1280 reported in their family a history of hyperten-sion. Mean SP in males was 146±19mmHg, while in females it was135±22mmHg. Mean DP was 85±39,9mmHg and 79±11mmHgrespectively. In all groups was found a negative association between age and DP.
A-A, Ca-A, B-B, and D A-A: angiotensin-converting enzyme inhibitors or angiotension IIblockers, D: diuretic, Ca-A: Calcium antagonists, B-B: beta=blockerThe percentage of hypertensive patients aged 20-29 years was 7%,30-39 was 12%, 40-49 years was 22%,50-59 years was 18%, 60-69years was 28%, 70-80 years was 15%.Conclusions: hypertension isless common among women than among men. The Moslems suffermore often from hypertension. Most of hypertensive persons arebetween 60-69 years and the association of an ACE-I with a diuretic is the most common hypertensive treatment.
CONCOMITANT LEFT ATRIAL MYXOMA AND ATRIAL FIBRILLATION
IN A PATIENT WITH CEREBRAL EMBOLISM
Alexoudis Apostolos, Borghi Luisa, Karakiriou Maria, Xaritos Stefanos,Dourtsiou Stella, Gotsis Alexandros, Terzi Sofia, Panagiotidou Alexandra CLINIC OF CARDIOLOGY, GENERAL HOSPITAL OF KOMOTINIGREECE Purpose: presentation of a rare case of left atrial myxoma causing atri-al fibrillation and cerebral embolismMethods: a 68-year-old man withatrial fibrillation (AF) was admitted to our department for electrocar-dioversion. The patient had been well until one year earlier, when hepresented dyspnea and fatique. Few months before admission, he washospitalized for multiple transient ischemic attacks and CT scan hadshown multiple cerebral infarctions. In the last months, there was ahistory of palpitations. The patient was referred to a cardiologist whodiagnosed AF, prescribed digoxin and acenocoumarol and planned thepatient for electrocardioversion. Any attempt to convert the AF withpropafenone or amiodarone in advance was useless. On admission, ahealthy looking man was seen, with no history of heart disease, pulsewas 80 b/min irregular, no murmurs and blood pressure was 145/80mm Hg. Chest radiographs revealed a mild pronounced pulmonarysegment and an enlarged left atrium. Electrocardiogram showed AFwith a low voltage pattern and abnormalities of ST segment caused bydigoxin.
Results: A transthoracic cardiac ultrasonographic study showed amobile echo mass in the left atrium, suspicious of a myxoma, anenlargement of left atrium, without segment wall-motion abnormali-ties. Using transesophageal echocardiography, it was evidenced a mass attacked to the rim of the fossa ovalis, which confirmed a myxo-ma. The patient underwent successful surgery and the histologicalexamination certified the diagnosis of the heart myxoma lackingmalignancy signs. Conclusions: The atrial myxoma is a rare cause of AF. This probablyoccurs through the enlargement of the left atrium or the invasion ofmyocardial tissue by the tumor.
STUDY OF LABORATORY TESTING IN PATIENTS WITH MALIGNANT
Alexoudis.A, Borghi.L, Kessidou.N, Asteriou.A, Kessidis.V, Karali.A,Koutsogiannis.O, Papanastasiou.S Emergency Department, General Hospital of Komotini Purpose: Our aim was to study patients affected by malignant tumorswho came to the emergency department with symptoms such asheadache, weakness, breathlessness and abdominal pain.
Methods: during 2003 were studied 52 patients (pts), with mean age65±13 years, 33 males and 19 females, 35 Christians and 17 Moslems.
In all patients were performed blood cell count, blood chemical testand X-ray control. Lung tumor diagnosis was made in about 26% aftera simple chest X-ray in the emergency department. Results: the primary tumor site was in: lungs (14 pts), colon (8 pts),liver (7 pts), stomach (5 pts), breast (3 pts), genitalia (3 pts), pancreas(3 pts), brain (2 pts), prostate (2 pts), rectum (2 pts), urinary bladder(1 pts), larynx (1 pt) and suprarenal glands (1 pts). Mean value of Hct(%) was 33,14 and Hb (gm/dL) was 10,8, while the erythrocyte sedi-mentation rate (ESR) was 40±31mm/1h. The mean value of cholesterolwas 183±46 mg/dL and of triglycerides 130±43 mg/dL. In the patientssuffered from lung tumor mean value of ESR was 40 mm/1h, liver 47mm/1h, colon 57 mm/1h while the highest value of ESR was noted instomach tumor (70mm/1h). The mean value of calcium was 9±0,65mg/dL and phosphatase alkaline (ALP) was 173±161 U/L. Patientsaffected by colorectal carcinoma and hepatocellular carcinoma had thehighest value of ALP. Only 12 patients had already metastasis and among them the lowestvalue of cholesterol and triglycerides concerned those with lung tumor(mean value of cholesterol 123±12 mg/dL and mean value of triglyc-erides 88±14 mg/dL).
Conclusions: Moslems males and Christian females are affected bymalignant tumors more frequently. Is seems that particularly low val-ues of cholesterol and triglycerides consist a very important prognos- tic factor of severity of the disease. QUALITY OF LIFE FOLLOWING AESTHETIC PLASTIC SURGERY:
A PROSPECTIVE STUDY
Papadopulos Nikolaos A1, Kovacs Laszlo1, Krammer Susanne1, Zim-mer Reinhilde2, Herschbach Peter3, Biemer Edgar1 1Department of Plastic and Reconstructive Surgery, Klinikum rechtsder Isar, Technical University of Munich, Munich, Germany2Department of Psychiatry and Psychotherapy, Klinikum rechts derIsar, Technical University of Munich, Munich, Germany3Institute of Psychotherapy and Psychology, Klinikum rechts der Isar,Technical University of Munich, Munich, Germany Purpose: The aim of this study was the prospective evaluation of qual-ity of life in patients undergoing aesthetic plastic surgery.
Method: 185 of our patients fulfilled the inclusion criteria for thisstudy (indication for aesthetic plastic surgery). 168 of these were con-tacted and 133 agreed to participate in our study. Until today 67patients (93,8% female, 6,2% male) completed the evaluation to thefirst follow up, 3 months post-operatively: 6 have had a breast aug-mentation, 3 mastopexy, 7 breast reduction by asymmetry, 16 breastreduction, 1 subcutaneous mastectomy by gynecomastia, 12 face andneck rhytidectomy, 3 rhinoplasty, 1 blepharoplasty, 11 liposuction, 5abdominoplasty, and 2 body-lifting.
As testing instrument served a standardized self-assessment test onlife satisfaction (FLZ) with a specific part on body satisfaction (FLZM),as well as a questionnaire for the evaluation of satisfaction with thesurgical result, the estimation of post operative complications, and theeffect of surgery on social and economical field. The patients werequestioned 2 times in totally, T0: pre-operatively, and T1: 3 monthspost-operatively.
Results: 76% of the patients were satisfied or very satisfied with theaesthetic result, 83,6% would undergo the same treatment again, andtwo thirds would further recommend the procedure they undergone.
More than the half of the patients did not report a decrease in physi-cal fitness or reduced social contacts in the direct post-operative peri-od. The satisfaction of life increased in one third of the patients.
Conclusions: Our study reveals that aesthetic plastic surgery is notonly well tolerated by the patients, but also increases the quality oftheir life.
Despite the limitations of our study, which occurred by evaluating var-ious surgical procedures in a short time follow up, we do further sup-port its continuation, for the better understanding of the effect of sur-gery on our patients. Therefore, we intend to divide our patients in dif-ferent study groups according to the surgical indication for the indi-vidual evaluation of the long term results on quality of life, in a simi-lar method.
CLINICAL OUTCOME AND QUALITY OF LIFE FOLLOWING
SIMULTANEOUS BILATERAL BREAST RECONSTRUCTION WITH
FREE AUTOLOGOUS TISSUE TRANSFER [FREE TRANSVERSE
RECTUS ABDOMINIS MUSCLE (TRAM) FLAP]
Nikolaos A. Papadopulos1, Laszlo Kovacs1, Samir A. Ammar1, MarkusKloeppel1, Peter Herschbach 2, Gerhard Heinrich2, Edgar Biemer1 1Department of Plastic and Reconstructive Surgery, Klinikum rechtsder Isar, Technical University of Munich, Munich, Germany2Institute of Psychotherapy and Psychology, Klinikum rechts der Isar,Technical University of Munich, Munich, Germany A review was performed on 34 patients who underwent simultaneousbilateral breast reconstruction with a free transverse rectus abdomin-is muscle (TRAM) flap between 1988 and 2001 in our unit. Long-termoutcome and patients' quality of life were assessed. After an averagefollow-up of 74 months, local recurrence of breast malignoma prompt-ing initial ablative surgery occurred only in one patient; in anothercase Paget's disease of the nipple developed after subcutaneous mas-tectomy. Overall, flap complications affected 13 of 68 flaps (19.1%).
Anastomosis revision was needed in 6 cases (8.8%), the salvage ratebeing 50%. The rates of total and partial flap loss were 4.4% and 1.5%,respectively. Bilateral flap loss did not occur in any of our cases. 4 outof our 34 patients developed donor site complications (11.7%), withwound healing problems being the most common (5.8%). Various pre-operative risk factors such as smoking, scars due to previous opera-tion, overweight and previous chest wall irradiation did not signifi-cantly affect the incidence of complications. Most of the patients weresatisfied with their decision to have had breast reconstruction with freeTRAM flap, 91% would choose the same operation again and 91%would recommend this procedure to other patients in similar circum-stances. After the reconstructive surgery 20,8 % of the operated thepatients felt an improvement in their sexual life. However, morepatients reported an improvement concerning their social life (37.5%)and life in general (50%).
INCIDENCE OF SIDE EFFECTS DURING HEMODIALYSIS
TREATMENT IN YOUNG AND ELDERLY PATIENTS.
Antoniadi G.,Tsiantoulas A.,Spanou Z.,Kapsos A.,Niavis G.,Dr. Barboutis K.
Dialysis Unit,General Hospital of Serres,Greece Background: The number of elderly patients in hemodialysis units hasincreased last years as a result of progress in medical care and the bet- ter efficacy of this treatment especially in aged population.
Such parameters as the frequency of symptomatic hypotensiveepisodes, the muscle cramps and the arrythmias during dialysis ses-sions characterized the quality of hemodialysis therapy.
The quality of hemodialysis and the comorbidity of these patients(including comorbidity of vascular access) strongly influence theirquality of life and survival.
Patients/Methods: We followed up a group of 18 stabilized patients (13male and 5 female) who started dialysis treatment after the age of 60years in comparison to another group of 16 patients (15 male and 1female) who started dialysis between the age of 20 and 50 years.
For a period of 6 months we studied:(a) The vascular access problems, the number of symptomatichypotension episodes, the appearance of muscle cramps and episodesof cardiac arrythmias during dialysis(b) The clinical problems relative to hypertension and coronary heartdisease.
Results: We found increased incidence of problems in elderly groupduring hemodialysis session in comparison to younger group. Forexample the frequency of symptomatic hypotension was 4.7% versus2.5% in the younger patients.
The frequency of arrythmias in elderly group was 2.5% versus 0.4% inyounger group.
In contrast, younger patients suffer from muscle cramps more fre-quently than the older (2.67% versus 1.3%).
Only 50% of patients in the elderly group had A-V F C.B. versus93.75% in younger group. As a consequence the older group had addi-tionally problems from temporary vascular access.
Hypertension and coronary heart disease were more frequent in elder-ly than in young patients (50% and 66.5% versus 13.5% and 5%respectively).
Conclusion: Age and comorbidity are two factors which influence thequality of dialysis therapy and concequently the quality of life.
Aged pts usually need increased care from physicians and nurses andthat means that hemodialysis treatment may be more expensive thanin younger people.
QUALITY OF LIFE AMONG CHRONIC HEMODIALYSIS PATIENTS AND
KIDNEY TRANSPLANT PATIENTS
Ospanova T., Semydotska Zh., Kotulevich N., Birjukova I. Dept. of Internal Diseases, Kharkiv State Medical University; RegionNephro-Urologic Center, 61174, 60, L. Svoboda av., fl.165, Kharkiv,Ukraine End-Stage Renal Disease (ESRD) is a non-curable condition for whichlife-long renal replacement therapy (dialysis or kidney transplantation)is required. Quality of life (QOL) is an important parameter of the treat- ment adequacy in hemodialysis (HD) and kidney transplant (KT)patients (pts). To determine how renal replacement therapy influencesQOL in ESRD patients, we conducted a study applying the KidneyDisease Quality of Life (KDQOL-36TM) questionnaires. KDQOL-36TM disease-targeted items focus on particular health-relat-ed concerns of individuals with kidney disease and on dialysis: Symp-tom/problems, Effects of kidney disease, Burden of kidney disease.
KDQOL-36TM also includes a SF-12 Physical health composite (PHC)and SF-12 Mental health composite (MHC).
A total of 102 patients with ESRD were included. 86 pts mean age 41.8± 1.47 years have been treated on chronic HD 4 hours 2-3 times perweek. Dialysis age was 30.4 ± 3.2 months. They were clinically stablewith a mean KT/V 1.18 ± 0.2. 62% of pts were under anti-hyperten-sive treatment. QOL parameters were also evaluated in 16 kidneytransplant patients mean age 39.3 ± 7.2 years. Results show a signif-icant impairment of quality of life in HD pts compared to the Generalpopulation for all parameters except mental health (p<0.05). Higherage and co-morbidity were associated with lower quality of life. Hyper-tensive patients who received ACEI Enalopril and/or Human recombi-nant erythropoietin (HrEPO) “EPREX” had higher qual-ity of life. Lower QOL was found in diabetic patients. Nutrition status,dialysis modality, gender, and age, dialysis term were the independentfactor which impact on QOL. QOL was better in all of domains exceptMHC in KT pts than in HD pts.
We conclude, KDQOL-36TM can be applied in evaluating of the ESRDtreatment. The QOL was better in transplant patients than in HD. Ane-mia correction, adequate treatment of hypertension, managing co-morbidity may improve QOL of pts who required renal replacementtherapy.
QUALITY OF LIFE IN PATIENTS WITH MULTIPLE MYELOMA IN
RECOMBINANT HUMAN ERYTHROPOIETIN ( RHU-EPO) TREATMENT
Caja T., Xhumari P.
University Hospital Center "Mother Tereza", Department of HematologyTirana-Albania Patients (pts) with Multiple Myeloma (MM) develop anemia that deterio-rates the quality of life and necessitates RBC transfusion, inevitable con-nected with the risk of complications. Improvements of quality of life aftertreatment with rHu-EPO often have been reported in pts with cancer.
Ojective: To evaluate the effectiveness of rHu-EPO in the treatment ofanemia associated with MM. Twenty pts with MM were enrolled into study. During the course ofchemotherapy all pts received rHu-EPO in the doses 150 U/kg threetimes a week subcutaneous. The pts were transfused when Hb levelfelt below 8.0 g/l.
Results: Anemia of different degree was observed in all pts. The indi- cations for RBC transfusion occured in 40% of pts on rHu-EPO treat-ment. Pts with response (80%) to the therapy significantly imrovedafter 8 weeks of treatment. The performance status before the start ofrHu-EPO therapy was more favorable and showed impressive improve-ment during the course of treatment. Clinical symptoms of anemiasubsided or at least considerably improved under successful rHu-EPOtherapy. No undesirable effects of rHu-EPO treatment were observed.
Conclusion: The use of rHu-EPO may reduce the requirements for RBCtransfusion in pts with MM under chemotherapy. RHu-EPO has anextended role in the managament of disease-related anemia and inquality of life in pts with MM. A SINGLE DOSE OF FRAXIPARINE PREVENTS INTRADIALYTIC
CLOTTING AND DYSLIPIDEMIA DURING HEMODIALYSIS
Neskovski J, Ognjanoski V, Naumcevska I, Krsteska T, Jovceski D,Cakalarovski K.
Department of Hemodialysis-Gostivar-FYROMDepartment of Nephrology-Skopje-FYROM"Cede Filipovski Road b.b" Gostivar-FYROM Hemodialysis is associated with extracorporeal blood flow. Anticoagu-lation is required to prevent clotting of the extracorporeal circuit. Stan-dard anticoagulation has traditionally consisted of unfractionatedheparin given as a bolus dose at start of dialysis followed by a constantinfusion of heparin or supplied with a mid-treatment dose. However,adverse effects of heparin include thrombocytopenia, platelet dysfunc-tion, increased bleeding risk and lipid abnormalities.
Thirty-one chronic uremic patients (18M, 13F; age, 67 + 13 yr) underhemodialysis treatment for 57+35 mo were studied. Among these, 16patients showed hypertriglyciridemia and- or hypercholesterolemia, evenwhile on a dietary and pharmacologic regimen of statins, the remaining15 patients did not have alterations. All patients were evaluated after 12mo period of employing std. heparin during each dialysis session. A sec-ond observation was undertaken after a period of the same durationemploying a similar dosing of Fraxiparine and without modifying thetype of dialysis, dietary behavior, or pharmacologic therapy. In allpatients, quarterly control values were obtained for serum glucose, uricacid, triglycerides, cholesterol, HDL, LDL,Kt/V and body mass index.
During the std. heparin period, cholesterol, triglycerides, and LDL weresignificantly increased in the 2 groups of dyslipidemic patients in com-parison with the 2 groups of normolipemic patients. During the secondperiod of observation however, the Fraxiparine patients demonstrateda significant decrease in serum cholesterol, LDL, and triglycerides.
We confirm the positive effect of Fraxiparine on lipid metabolism whencompared with standard heparin sodium. Fraxiparine, therefore-inassociation with dietary and/or pharmacologic measures-could find anindication for those patients with evident lipid alternations. EPIDEMIOLOGICAL CHARACTERISTICS OF WOMEN IN CENTRAL
GREECE WHO ATTENDED THE MAMMOGRAPHY SCREENING
PROGRAM OF LAMIA'S GENERAL HOSPITAL
Paliogianni E, Koutsogianni Z, Mantouvalou M, Mpakolas B, Kouvelis E Department of Radiology, General Hospital of Lamia , Fthiotid, P.C.
35100 Greece BACKGROUND AND GOALS OF STUDY. The aim of our study is todescribe the epidemiology and the characteristics of all the womenusing the mammography screening program of General Hospital ofLamia. A total of 910 screening mammograms were performed fromMay 2003 to February 2004.
MATERIAL AND METHOD. All women filled in a questionnaire abouttheir age, income and education level as long as family history ofbreast cancer.
RESULTS. The mean age was 54 years with an age range from 38 to78 years. Only 10% of the women had academic education. The major- ity of them (60%) were unemployed.
ATTITUDE OF THE PHYSICIANS IN THE ROLE OF MAMMOGRAPHY
AS A SCREENING TEST FOR BREAST CANCER. PRELIMINARY
RESULTS FROM THE FIRST YEAR OF MAMMOGRAPHY SCREENING
CENTER OF LAMIA, GREECE.
Mantouvalou. M, Paliogianni E., Koutsogianni Z., Koutsogiannis I.,Kouvelis E.
Department of Radiology, General Hospital of Lamia Fthiotida, P.C.
35100 Greece BACKGROUND AND GOALS OF STUDY: our goal was to study attitudeof physicians from different specialties against mammography as ascreening test either for prevention or for early diagnosis of breast cancer.
MATERIAL AND METHOD: Healthy women aged 38 -78 years wereinvited to complete a standard anonymous questionnaire when attend-ing the mammography screening center. among other questionswomen were asked who advised them to undergo a mammography, ifthey were aware of the role the mammography plays in breast cancerdiagnosis and staging and finally if they had had a physical examina-tion including breast palpation.
RESULTS: interestingly enough the vast majority of the women thatcame for a mammography were advised to do so from a gynaecologist.
these women were also physically examined before doing the test. Only9% of the women was sent from a general practitioner. Many women had been informed about mammography from mass media or fromfriends and / or relatives.
CONCLUSIONS: The authors recommend a multifaceted approach toincrease mammography screening by women from central Greece, rec-ommendations from the provider plus targeted education to addressthe effectiveness of screening mammography compared with clinicalbreast examination.
QUALITY OF LIFE FOR CAREGIVERS OF ALCOHOLIC PEOPLE
Sitzoglou K, Papadopoulos K, Papadopoulou G, Tsiptios J, Pervos I,Charalampous Ch, Chatzimaroulis K.
Department of Clinical Neurophysiology, Mental Hospital of Thessa-loniki. Internal Medicine Clinic, Mental Hospital of Thessaloniki. Caregivers are persons who provide care to those who need supervisionor assistance in illness or disability. They may provide the care in thehome, in a hospital, or in an institution. Although caregivers includetrained medical, nursing, and other health personnel, the concept alsorefers to parents, spouses, or other family members, friends, socialworkers, fellow patients. Our study has focused to parents, familymembers, family mates. It was performed in order to investigate andmeasure the quality of life for caregivers of the alcoholics.
Initially we have examined the alcoholics during their hospitalizationfor the somatic detoxication. The sample consisted of n=87 subjectssuffered from alcoholism (men=72,women=15). The mean use of alco-hol was 21±8.9 years and 11±5.2 years for the men and the womengroup respectively. Afterwards, we examined the caregivers of theaforementioned patients. Those ones were asked to complete a ques-tionnaire based on the health related quality of life, the questionnaire31 and a supplementary group of questions regarding their financial,social, emotional, working and psychophusiological status. 75 out ofthe 87 caregivers were reciprocating to our request. Results suggest that caregivers are strongly stressed emotionally. Theyare forced to work more in order to cover the financial gap that is orig-inated from the joblessness of the alcoholics. They have presentedsevere sleep disturbances They also lack patience and they are irrita-ble from the point of view that they offer constantly to the alcoholic andthey don't receive anything from the alcoholic. Especially those thatare women caregivers are victims of violence. Finally, 59 out of 81 couples live separately or they even have beendivorced.
Thus, caregivers in this study experienced a lower quality of life thanhealthy mature people. People with alcohol abuse even after treatmentconstruct a group from which family and gregarious problems origi-nate constantly. Alcoholics are proved to be a substantial problem forthe family of the alcoholics especially in the economic portion Ourquestionnaire allows a measurement of quality of life for caregivers ofthe alcoholics.
SEXUAL LIFE AND QUALITY OF LIFE IN GREEK PATIENTS WITH
A Dourouma, R Pita, G Kiosseoglou & A Orologas School of Psychology, Aristotle University of Thessaloniki, Greece2nd Neurological Clinic AHEPA Hospital, Thessaloniki, Greece and the Greek Multiple Sclerosis Society (Thessaloniki Branch) The aim of our study was to evaluate the quality of life (QoL) of Greekpatients with multiple sclerosis (MS), as related to sexual life anddemographic data. The participants were 51 patients (30 women and21 men) with clinically definite MS diagnosis. Their average age was36.5 yrs (the age span was 19 to 61) and the average disease durationwas 9.2 years (span 3 to 28 years). Of the participants, 59.7% sufferedof chronic progressive, while 40.3% suffered of relapsing-remitting typeof MS. The participants were administered the GRISS (Golombok &Rust, 1986) for assessing possible sexual life dysfunction, and theQOLIE-89 (Vickrey et al., 1993) for assessing their QoL. Concerning the GRISS factors, the correlational analysis betweendemographic data and sexual life factors revealed that ‘anorgasmia'correlated with the type of disease in women, while duration of illness,type of MS and education level correlated with ‘premature ejaculation',‘non-sensuality' and ‘non-communication' in men. Correlational analy-sis among GRISS factors and QOLIE-89 factors indicated a differentialprofile of relations in male and female patients. Specifically, the sexu-al life of female patients correlated with ‘emotional well-being', ‘relapseworry' and ‘social isolation' of QOLIE-89. On the other hand, the sexual life of the male patients correlated with‘memory', ‘language', ‘attention-concentration' and ‘energy/fatigue'factors of QOLIE-89. These results of our preliminary research are inaccordance with extant literature.
THE INFLUENCE OF ERYTHROPOIETIN ALFA ON LEFT
VENTRICULAR HYPERTROPHY (LVH) IN PATIENTS WITH PRE-
DIALYSIS STAGE OF CRONIC RENAL FAILURE (CRF)
Margarita Gjata, Alma Idrizi, Mihal Tase, Myftar Barbullushi, AlketaKoroshi, Sazan Celiku, Edmoand Zaimi Service of Nephrology, Internal Medicine and CardiologyUniversity Hospital Centre " Mother Teresa", Tirana, Albania In renal disease anaemia is a risk for cardiovascular disease, such asleft ventricular hypertrophy in both patients with early renal diseaseand dialysis patients. During the past decade, many studies haveshowed that partial correction of anaemia leads to partial regression of LVH in hypertensive and normotensive dialysis patients. Severalreports support the pre-dialysis use of epoetin. Evidence of cardiovas-cular risk reduction with epoetin treatment in pre-dialysis patients isgrowing. The aim of the study was to evaluate the effect of the correc-tion of anaemia with erythropioetin alpha (Eprex) on LVH. We studied 50 patients in pre-dialysis stage of CRF, 37 men and 13women from 26 to 60 years old, mean age 44.2 years with hemoglobinlevels < 9 gr/dl. Patients were followed up during six months after theinitiation of the treatment with Eprex, from January 2002-June 2002. The main basal hemoglobin being 8.3 gr/dl, significance increase to11.2 gr/dl was observed at the 6th month of the study. The mean ini-tial dose of Eprex 85 U/kg/week with an important decrease of therequired maintain dose to 60 U/kg/week at the 6 months. On echocar-diography, the end-diastolic-diameter and left ventricle mass index(LVMI) were decreased moderately. Moreover, a significant reduction ofthe end-diastolic diameter of the posterior wall of left ventricle wasobserved: from 12.85 mm at the beginning to 11.06 mm at the 6thmonth (p < 0.05). In conclusion, the treatment with Eprex led to satisfying correction ofanaemia and to an important improvement of LVH. LIPID PROFILE IN CORONARY PATIENTS WITH A NEW ACUTE
M.Barparousis, D.Frontzou*, Z.Koutsogianni*, P.Panagiotopoulou,A.Antonoulas, K.Filis Cardiology Department and General Practitioners* of General Hospitalof Lamia, Fthiotida, Greece. P. C. 35100 AIM: Decreasing of lipid levels after a coronary event plays an impor-tant role in preventing a new coronary event. The aim of our study wasto measure the lipid levels in coronary patients (pts) with a new coro-nary event and if they reach the goal for LDL cholesterol.
MATERIAL AND METHODS: We studied 109 coronary pts (84 men and25 women) with a new coronary event and we measured ,in admission,total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol andwe calculated the percentage of pts who had reached the goal for LDLcholesterol (<100mg/dl) with or without treatment.
RESULTS: The average age of pts was 67±10.69 years (66.35± 10.95 inmen and 71.64± 8.76 in women). The lipid levels were: total cholesterol201± 43.53mg/dl, triglycerides 146±57.99mg/dl, HDL cholesterol49±9.51mg/dl, LDL cholesterol 122± 37.36mg/dl. 28.44% of pts weretreated (30% in men and 24% in women) and 27.5% of pts (28.6% inmen and 24% in women) had reached the goal for LDL cholesterol.
Among treated pts only 45.16% had LDL cholesterol <100mg/dl.
CONCLUSIONS: The majority of coronary patients did not succeed todecrease lipid levels and reach the goal for LDL cholesterol after a coro-nary event, even they were treated and to decrease the risk for a newcoronary event. QUALITY OF LIFE FOR PEOPLE WITH ALZHEIMER'S DISEASE
THEOFANIDIS D1, FITSIORIS F2, FOUNTOUKI A3, RUDOLF G2.
1Technological Educational Institute of Thessaloniki2Neurological ward, "PAPAGEORGIOU" General Hospital,3Neurosurgical ward, "AXEPA" General Hospital, Introduction: Dementia is a dramatic life-long condition affecting thefamily as a whole. An illness of this magnitude may result in familyconflicts and demoralization. Housekeeping becomes the spouse's totaland long-term responsibility while he/she may also faces a financialburden. In any endeavor to improve quality of care it is important tomaintain a perspective on how the individual is affected by the inter-vention and the institution (hospital, community setting or home)where it takes place.
Objectives: Our aim was to compare the level and advantages of care inthree different settings, that is, hospital, community setting or home.
Methods: Literature search through Medline, Cinhal and Vivisimo,with 154 articles being identified and 93 included in the analysis.
Results: Lack of activity is the predominant feature in hospital wherepatients continue to have little in the way of meaningful social inter-action and not enough is done to help the person maintain his/hersense of identity. As for community settings, they seem to remain geo-graphically and functionally isolated from the patient's family, friendsand the wider community.
Conclusions: Staff in hospitals and community settings need help toavoid burn-out in their work when caring for demented patients inorder to offer enjoyable activities. The cares of demented patients isbest delivered at home. However, organized help is necessary if the car-ers are to provide for the patient at home, without having to look for along-term facility.
ATTITUDE AND BEHAVIOR OF WOMEN IN FTHIOTIDA (GREECE) ON
MAMMOGRAPHY SCREENING AND FOLLOW-UP FOR BREAST
Paliogianni E., Koutsogianni Z. , Mandouvalou M., Sfiras D., Kouvelis E.
Department of Radiology, General Hospital of Lamia ,Fthiotida, P.C.
35100 Greece BACKGROUND AND GOALS OF STUDY. We studied 910 women agedbetween 38 and 78 years, who came for a mammography at LamiaGeneral Hospital. Our goal was to show their attitude and knowledgeagainst mammography screening test.
MATERIAL AND METHOD. All women filled in a questionnaire about how many mammograms they had in the past and if they were willingto repeat the test over a period of 1, 2 or 3 years. RESULTS. 60%.of the women had had one mammogram in the resentpast. The majority of them had only one mammogram. The highestincidence ( 70%) occurred in women between 50 and 69 years old,while younger ( 39-49 )and older ( >70 ) women had a significantlylower incidence (40% and 45%). Only 5% however knew about the rec-ommendation to have a mammogram every one year after the age of39. From the total 910 women only 27% agreed to repeat the test inthe future (11% in one year, 12% in two years and only 4% in threeyears.)CONCLUSIONS. The majority of women were unaware of the necessityof the yearly follow-up. 80% of women over sixty ( a group of age par-ticularly susceptive to breast cancer ) was unwilling to repeat the testin the next three years while younger women are more sensitized to therole of mammography. Absence of a well organized, national screeningprogram in Greece, especially in the countryside. There is no informa-tion especially in the lower socioeconomic groups of women as well asthe elderly.
∆∏∂ CONTRIBUTION OF GROUP OF PARENTS TO THE
IMPROVEMENT OF THE COMMUNICATION AMONG FAMILY
Child Psychiatrist, Child Psychiatric Department, Community MentalHealth Centre of Katerini, Greece We present the results of our work with two groups of parents thatlasted two consecutive academic years. This was a collaborative effortbetween the interscientific group of our Child Psychiatric Departmentof Community Mental Health Centre of Katerini and the local schoolcommunity. The aim of the first group, consisting of 25 parents, was the prepara-tion of parents for the adolescence of their children. The aim of the sec-ond group, with 12 participating parents, was to support and help par-ents dealing with the needs of their preschool children.
The subjects discussed in the 12 meetings organised for each groupwere selected by the parents. It was impressive that from the beginning the parents showed a stronginterest in the discussion. An emotional atmosphere of trust and famil-iarity was soon developed among group members.
At the end, the effectiveness of this intervention was evaluated bycompletion of a specifically designed questionnaire by the parents. Inconclusion, the participation of parents in these groups helped themto comprehend better the emotional needs of their children and result-ed in an improvement in the communication not only among family members, but also among teachers and parents. GASTROINTESTINAL BLEEDING AND VIRAL HEPATITIS IN DIALYSIS
M. Malliara, D. Kougioumtzoglou, G.Voutiadou Z. Diamantis.
Renal unit, General Hospital of Katerini, Greece. Gastrointestinal bleeding is a common complication in patients onhemodialysis. Angiodisplastic lesions and duodenal ulcers reported tobe the most frequent causes of bleeding in these patients population.
The purpose of the study was to examine the frequency, causes ofbleeding and to correlate this with the presence of viral hepatitis(B orC) in the patients undergoing hemodialysis. Patients-Methods: Wehave retrospectively evaluated patients undergoing maintenance HDthat suffered from GIB the period from 1999-2004 from a global pop-ulation of 130 patients. 15/12(13%) suffered from at least one GIBepisode in this period. Males were:8/15(53%), mean age:62,5y(45-80y)and mean duration in dialysis: 52m(SD:51,2m). Esophagogastroduo-denoscopy and colonoscopy where needed performed in patients toestablish the cause of GIB and to identify in gastric mucosa biopsieselicobacter pylori positive patients. Results: the cause of GIB was: duo-denal ulcer in:4/15(25%), angiodysplastic lesions in:6/15(40%), use ofanti-inflammatory drugs in: 3/15(20%), intestinal ischemia :1/15(4%),hemorrhoids in:4/15(25%), polyps in:2/15(13%).12/15 (80%) of thepatients that suffered from GIB had a chronic infection from HBV orHCV.The prevalence of GBI in during the follow up was greater inpatients with HBV or HCV than in those without it (p<0,05). All patientswith angiodisplasia had a chronic infection from B or C hepatitis . Heli-cobacter-pylori(+) :revealed in:5/15( 30%) of these patients. Admittedto the hospital 8/15(53%) patients for a mean period of 2 days. Conclusions: patients under hemodialysis treatment have high inci-dence of GIB, especially among those with coexisting viral hepatitis. Inpatients without viral hepatitis the causes of bleeding were similar tothe general population. Angiodisplasia is the most frequent cause ofrelapsing GIB in HBV or HCV positive hemodialysed patients.
PRESENCE AND SEVERITY OF DEPRESSION IN DIALYSIS PATIENTS
M. Malliara, G. Voutiadou, D. Gitiridis M. Xafenias.
Renal Unit, General Hospital of Katerini, Greece. AIM: to evaluate the presence and severity of depression in our dialy-sis patients. Patients-methods: in a total number of 51 patients we gave a quas-tionnaire of 21 multiple choice questions. The patients chose onestatement from among the group of four statements in each question that best described how they had been feeling during the past fewdays. This questionnaire was developed by a psychiatrist (BeckDepression Inventory)We compare their total to the scoring chart. Results: 45/51(88%)returned answers. Males were:34/45(76%), mean age 65,5y(SD:12,5y)and mean duration in dialysis:54months(SD:53,1m). 40/45(89%) diag-nosed to suffer from moderate depression. 4/45(9%) from severedepression and 1/45(2%) from extreme depression. All patients(100%)answered that they feel sad with their illness. 40/45(89%) feel thatthey have failed more than an average person.42/45(93%) don't enjoythings the way they used to. All( 100%) feel that they may be punished.
36/45(80%) cry more than they used to. 40/45(89%) are slightly moreirritated now than usual. 100% feel that there are permanent changesin their appearance now. 36/45(80%) have to push themselves veryhard to do a work. 35/45(78%) wake up several hours earlier than theyused to and they cannot back easily to sleep. 40/45(89%) answeredthat they get tired more easily than they used to. 36/45(80%) haven'tlost more than five pounds the last month and their appetite is not lessthan before. 44/45(98%) are very worried about physical problems andthey feel afraid for the future complications. 40/45(89%) are much lessinterested in sex now. Conclusions: the depression in dialysis patients is very common com-plication strongly related with their primary disease. It is very impor-tant for our patients to give them support with the social worker andthe psychiatrist where needed. Many times the role of psychiatrist isup to the nephrologists.
THE METABOLIC SYNDROME IN PATIENTS WITH ACUTE CORONARY
M.Barparousis, D.Frontzou*, Z.Koutsogianni*, P.Panagiotopoulou,A.Antonoulas, K.Filis Department of Cardiology and General Practitioners* of General Hospi-tal of Lamia, Fthiotida, Greece, P.C. 35100 AIM: The aim of our study was to show if metabolic syndrome (MS)includes a number of risk factors which leads to increased probabilityof developing coronary artery disease. The incidence of metabolic syn-drome in patients (pts) with acute coronary syndromes (ACS) seems tobe increased.
MATERIAL AND METHODS: We studied 123 pts ( 96 men and 27women) with ACS (Acute Myocardial Infarction Q-AMI Q, AMI NON Q,Unstable Angina-UA) and we measured HDL cholesterol, triglycerides,glucose, blood pressure and waist circumference and we used theNCEP criteria to define pts as having metabolic syndrome or not. TheNCEP (National Cholesterol Education Program) has defined individu-als with the metabolic syndrome as having 3 or more of the followingcriteria: waist circumference >102cm in men and >88cm in women, triglycerides >150mg/dl, HDL cholesterol <40mg/dl in men and<50mg/dl in women, blood pressure (BP) >130/85mmHg, glucose>110mg/dl.
RESULTS: Mean age was 66 with an age range from 55 to 77 years.
The average for HDL cholesterol was 48.6± 8.37mg/dl, for triglycerides164 ±73.9 and for waist circumference 101± 6.82 cm. 70% of the ptshad BP >130/85mmHg and 59.3% of the pts had glucose >110mg/dl.
The percentage of pts with MS was 58.5% totally, 51% in men and 85%in women.
CONCLUSIONS: The metabolic syndrome is a common characteristicin patients with acute coronary syndromes, especially in women and itmust be treated in order to prevent coronary artery disease. PSYCHOLOGICAL PROFILE OF RACE DRIVERS WITH PTSD
Alexopulos G. Christos Neurosciences Department, Medical Faculty Kragujevac, P.O.BOX 7134000 Serbia and Montenegro Car racing is currently one of the most popular sports. The aim of thisstudy is to establish the profile of persons with posttraumatic stressdisorder by using psychological criteria (MMPI). Psychiatric measure-ments (HAMD, HAMA, API) are exploited to detect differences betweenacute and delayed type of PTSD on the level of depression, anxiety, andreadiness for panic. The research included 30 drivers: 20 have reactedwith acute and 10 with delayed onset of PTSD. Diagnosis criteria wereDSM-IV. The scores on subscales at MMPI personality profile for acute anddelayed type of PTSD, are much higher D and Hy, in relation to nor-mal. The structural correlates D and HS appear with a higher level inthe delayed PTSD. There is a higher level of depression and of anxiety.
There is no statistical difference between acute and delayed PTSD, asfar as the panic is concerned. However, the results concerning drivingrisk remain controversial. PSYCHOSOCIAL CONSEQUENCES OF HALITOSIS
Karnoutsos K , Mplioumi E., Ganidou M. , Petrou C., Floras T., Ste-fanidis S.
General Hospital of Thessaloniki, AGIOS PAVLOS, Dental Department161 ,Ethnikis Antistasis Str. 55134, Thessaloniki Greece Diagnosis and treatment of bad breath is a matter that relates to a large portion of general population and dentists. Malodorous volatilecomponents which are produced by some bacteria on the dorsal sur-face of the tongue are the main cause of bad breath. These are mainlyvolatile sulfur components, especially methyl mercaptan and hydrogensulfide, but also short-chain fatty acids and polyamines. It appearsthat the gram negative anaerobic microflora is responsible for odor for-mation .through a two-phase metabolic process. Other metabolicprocesses which result in PH decrease, O2 decrease or Eh increasefavor the growth of gram negative anaerobes and the generation of mal-odor. The three main methods of analyzing oral malodor are organolep-tic measurement, gas chromatography and sulphide monitoring. Athorough medical and dental history helps the dentist to find the ori-gin of halitosis and classify halitosis into three different categories,which are genuine halitosis (physiologic and pathologic), pseudo-hali-tosis and hatitophobia Furthermore, a thorough extraoral and intrao-ral examination may eliminate from consideration some other extrao-ral and intraoral causes of bad breath . The treatment of malodor con-sists of mechanical and chemical reduction of microbial flora. Themost common ways of treatment are cleaning the tongue with a den-talcleaner or a dentalscraper, use of mouthwashes containing zinc,chlorexodine and hydrogen peroxide and periodontal treatment.
Patients with pseudo-halitosis and hatitophobia need to be counseledand assisted by a psychological specialist. In conclusion, since malodoris a common condition in general population, all dentists ought to be informed in the causes, the diagnosis and the treatment of halitosis.
MALNUTRITION - RELATED POLYUNSATURATED FATTY ACIDS
(PUFA) PROFILES IN PLASMA PHOSPHOLIPIDS IN HEMODIALYSIS
Pekovic-Perunicic, G. Rasic, Z. Ristic,V. Pljesa, S.
Department of Nephrology, University Hospital Zemun, Belgrade11000 SCG Long-chain PUFA play a key role in membrane structure and in con-trol of cellular function by influencing the activity of some importantenzymes and receptors. In addition, PUFA with twenty carbon atomsare the precursors of prostaglandins and related eicosanoids. Long-chain PUFA result from desaturation and elongation of essential fattyacids (EFA). This process requires adequate nutritional status. Aim of our research was to establish phospholipids fatty acid profile,lipids level and nutritional parameters in hemodialisys patients. We examined 21 HD patients with moderate mlnutrition and 23healthy controls. For nutritional assessment three simple parameterswere used: triceps skinfold (TSF), mid-arm muscle circumference(MAMC), serum albumin concentration (SA) and prealbumin (PA) asrepresentative of body fat, muscle protein and visceral protein respec-tively. We measured their plasma levels of a variety of lipids and lipoproteins.
Lipid fractions, trigliceride (1.87 ± 0.92 vs 1.20 ± 0.40) and HDL cho-lesterol (1.34 ± 0.38 vs 1.22 ± 0.45) differed significantly betweengroups. Plasma phospholipids fatty acids profile of HD patients showedlower a - linolenic acid - LNA (0.42 ± 0.2 vs 0.48 ± 0.3 % of total) anddokosahexaenic acid - DHA ( 2.93 ± 0.9 vs 3.63 ± 1.1). Plasmamonounsaturated fatty acids (MUFA) and plasma saturated fatty acids(SFA) were not differed between groups. There is correlation betweenPUFA and diastolic blood pressure (p<0.05). The study confirmed the presence of an essential fatty acids deficien-cy in HD patients. The results of indicate that the oral supplementa-tion of essential fatty acids maybe improves the nutrition parameters,quality of life and decreased inflammatory responses.
SOCIAL ISOLATION DUE TO HIRSUTISM IN A KIDNEY TRANSPLANT
RECIPIENT TREATED WITH CYCLOSPORIN
G. Vergoulas, Th. Eleftheriadis, A. Avdelidou, K. Ioannou, Gr. Miserlis,F. Solonaki, A. Papagiannis, D. Takoudas Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki,Greece Background: Immunosuppression is unavoidable for renal graft sur-vival, but causes side-effects which can compromise patient's qualityof life. A cyclosporin's side-effect, which occasionally leads to patient'snon compliance, is hirsutism.
Case report: We describe the case of a male patient, 20 years old, withESRD because of Alport's syndrome. After a 5 month period onhemodialysis, the patient had a renal transplant from his father.
Cyclosporin was included in the immunosuppressive regimen, asusual. Soon the patient developed heavy hirsutism of the face and thebody which affected his mood and social behavior. Despite his youth the patient was withdrawn from his daily activities,became social isolated and declared that is not going outside homeagain. Because of this and despite the good graft function CsA wasconverted to tacrolimus 3 months after transplantation. Hirsutism dis-appeared and both mood and behavior of the patient was restored.
Regarding the other side-effects, the conversion from cyclosprin to FK-506 was accompanied by mild neurotoxicity in the form of a fine handtremor. On the other hand patient's graft function remained normal,blood pressure was restored to normal and anti-hypertensive drugs(nifedipin 60 mg/d and atenolol 50 mg/d) were withdrawn. There wasalso a decline in total cholesterol levels. Conclusion: CsA caused major behavioral problems to our patientbecause of hirsutism. Tacrolimus was selected with aim to preserve thepatient in the best possible physical, psychological and mental statusas it is determined by objective measurements and by patient's partic-ular psychism. The outcome was satisfactory.
MYCOPHENOLATE MOFETIL LATE GASTROINTESTINAL TOXICITY
AFTER RENAL TRANSPLANTATION
Vergoulas G, Avdelidou A, Ioannou K, Eleftheriadis Th, Miserlis Gr,Solonaki F, Nikolaidis N, Giouleme O, Leontsini M, Dounousi E, Papa-giannis A, Takoudas D.
OrganTransplant Unit, Hippokratio General Hospital, AristotelianUniversity of Thessaloniki, Thessaloniki, Greece. After the improvements in short and long-term patient and graft sur-vival in kidney transplantation, the attention is focused on the qualityof life of these patients. Immunosuppression has been implicated forside effects that can compromise patients' quality of life. We describetwo patients with intractable diarrhea due to mycophenolate mofetiltoxicity.
A man 40 years old with a living related donor and a woman 33 yearsold with a cadaveric donor presented intractable diarrhea four yearsand three months and three years respectively after transplantationwhich caused a loss of 12 Kg and 8 Kg of weight respectively. Theduration of the diarrhea was 25 months for the male and 18 monthsfor the female patient with exacerbations and remissions during thisperiod of time. Anti-diarrhoeic agents such as loperamide and nifurox-azid were used to control diarrhea, as well as antibiotics (metronida-zole, ciprofloxacin) without any result. The investigation of thesepatients started a few months after the initiation of the symptoms andincluded upper and lower gastrointestinal endoscopy with repeatedcultures and biopsies and barium radiographs of small intestine. Allthe examination results were negative for malignancy, inflammatorybowel disease or malabsorption syndrome.
MMF was converted to azathioprine (100 mg/d p.o) and the diarrheastopped in both patients. They gained weight 5 kg the male and 4.5 kgthe female patient during a period of time of less than two months andthere was no change in their serum creatinine levels.
In conclusion, mycophenolate mofetil late gastrointestinal toxicity caus-ing diarrhea seems to exert an important negative influence on thequality of life of kidney transplant recipients, which we have to take intoconsideration. Conversion of immunosuppressive therapy from MMF toAZA resulted in prompt diarrhea discontinuation and improvement ofquality of life of these patients, without affecting graft's function.
PROFILE OF RENAL TRANSPLANT RECIPIENTS WITH MORE THAN 10
YEARS FOLLOW UP
G. Vergoulas, C. Tasiopoulou, A. Angelou, Gr. Miserlis, I. Katsara, V.
Papanikolaou, K. Ioannou, A. Avdelidou, G. Sakellariou Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki,Greece The aim of this study was to investigate the factors related with long –term graft survival. Of 293 transplants performed from 1.1.1987through 17th December 1993, eighty-three of them had > 10 years fol-low up. The recipients were 37 years old (range 16-64 years), therewere 57 men and 26 women who had a mean follow up 12.75 years(range 10.02 to 16.63 years). They received triple or quadruple sequen-tial immunosuppression (steroids, azathioprine, cyclosporine, ALG).
Clinical and laboratory posttransplant variables measured in the 7th,15th posttransplant day, 1st, 3rd, 6th month and then yearly up to the10th posttransplant year (body weight (BW), systolic and diastolicblood pressure (SBP, DBP), serum creatinine (Scr), serum total protein(Stp), serum albumin (Sal), total cholesterol (Sch), triglycerides (Str),24 hour proteinuria) as well as pre and posttransplant factors (delayedgraft function (DGF), acute rejection (AR), donor age, graft origin, HLAmatching, complications) were analyzed. Repeated measures analysis,paired and independent t tests as well as descriptive statistics wereused for statistical analysis. There were 51 LRD and 32 cadaveric graft recipients (mean coldischemia time 11.5 hours). Six common HLA antigens were in 4 cases(5.1%), 5 in 6 cases (7.7%), 4 in 5 cases (6.4%), 3 in 49 cases (62.8%),2 in 9 cases (11.5%) and 1 in 5 cases (6.4%). AR was recorded in32.5% of cases (15 cases with a LRD and 12 with a CAD). DGF wasrecorded in 11 CAD transplants (34.4%) and in 8 LRD transplants(15.7%). Scr levels (6th month mean: 1.42 mg/dl, 1st year mean: 1.40mg/dl) fell significantly during the 1st posttransplant year (p=0.002)and remained stable up to the 10th year (Scr: 1.68 mg/dl). Stp andSal rose significantly up to the 5th year (p < 0.0005) and thenremained stable up to the 10th year. In 17 cases there was protein-uria > 0.25 g/24h which had no correlation with AR. BW increasedsignificantly during the ten year follow up (p<0.0005). Sch rose sig-nificantly up to the 3rd posttransplant month compared to pretrans-plant levels (p=0.005) and remained stable up the 10th year. The per-centage of hypercholesterolemic patients was 77.3%. Hypolipedemicagents were given in 41 pts. Triglycerides did not show significantchange during the 10-year follow up. SBP and DBP presented a sig-nificant fall during the first 3 posttransplant years (p<0.0005). At theend of the 10th posttransplant year 64.6% of pts were hypertensives.
The infections were 0.61 per patient year, 5 pts had organ and 6 ptsskin cancer, 19 pts had bone disease, 3 diabetes, 4 HCV and 4 HBV.
Nineteen grafts were lost (chronic allograft nephropathy in 11, deathin 8 cases). Ten of the 11 patients with graft loss due to CAN werehypertensive. There was no correlation between graft loss and pro- teinuria or hypercholesterolemia. Only 4/11 lost grafts had acuterejection history and 1/11 had DGF. The cause of death was cere-brovascular accident in 1 case, cardiovascular accident in 4 cases,infection in 2 cases and pancreatitis in 1 case. Immunosuppressionwas converted from azathioprine to mycophenolate mofetil in 46/83pts.
In conclusion graft survival > 10 years was related with a serum crea-tinine < 1.5 mg/dl during the 1st posttransplant year and short coldischemia time. Acute rejection and DGF did not affect long – term graftsurvival. The reasons of graft loss were CAN and death. The main rea-son of death was cardiovascular accidents.
COMPARATIVE STUDY OF OXIDATIVE STRESS IN PERITONEAL
DIALYSIS (PD) AND HEMODIALYSIS (HD) PATIENTS
D. Yonova , I. Trendafilov, V. Papazov, R. Zidarov and S. Antonov Dialysis Clinic, Medical University Hospital "Alexandrovska", Sofia, p-1431, Bulgaria Two general types of extrarenal depuration are used in patients withterminal uremia – peritoneal dialysis (CAPD) and hemodialysis (HD).
All uremic patients are exposed to oxidative stress, due to uremia "perse" and some artificial materials are suspected as well, but not sure-ly proved.
The study compares some plasma markers of oxidative stress in 28patients on CAPD (1st group) ( 12 males and 16 females) and 28 HDpatients (2nd group), (14 males and 14 females) more than 3 years ondialysis: MDA and oxidized LDL (ELISA) and, of antioxidant activity:enzymatic - glutathione peroxidase (GPx) (enzymatic assay): and non-enzymatic factors: vitamin E and vitamin C (HPLC). All patients - non-diabetic and without peritonitis – were tested for above mentioned bio-chemical markers (before HD for the 2nd group). The results showed in CAPD patients a not-significant lower levels ofmarkers of oxidative stress and a mild significant higher antioxidantactivity for vitamin E and GPx, than in HD group. Although the exis-tence of oxidative stress was proved in both groups: The found valuesfor 1st /2nd groups were as follows: MDA 6.21±0.31Ìmol/l versus6.31±0.23Ìmol/l (p n.s.); oxidized LDL 360±234mU/ml versus376±252mU/ml (p n.s.); GPx 18.1±5.6Ìmol/Hb versus14.6±4.9Ìmol/Hb (p<0.01) and vitamin E 25.7±4.1 Ìmol/l versus21.7±5.2Ìmol/l (p<0.01); vitamin C 53.11±25.0Ìmol/l versus50.24±25.2Ìmol/l (p n.s.)The findings suggest that uremia is playing the main role in oxidativedamages even in dialysis faze of chronic renal failure, but CAPD seemsto be slightly more bio-compatible than conventional HD for thepatients, probably because of the greater number of artificial materialsused in the late. In conclusion dialysis patients more or less need someantioxidant treatment in both dialysis procedures – CAPD or HDdespite CAPD has some advantages.
SOFT TISSUE CALCIFICATIONS AND THEIR RELATION TO PTH IN
PATIENTS ON HEMODIALYSIS TREATMENT (HDT)
Yonova D1., Georgiev M. 1, Dukova P. 2, Antonov S.1 Dialysis Clinic1, Centr. Med. Lab.2 Medical University Hospiital"Alexandrovska", Sofia, p-1431, Bulgaria The aim of the study: To evaluate the dispersion of vascular and periar-ticular soft tissue calcifications of a random group of HDT patients andtheir relation to PTH (parathyroid hormone) and some other biochemicalmarkers.
Material and methods: 4 middle-range arteries a.a. carotis communissinistra et dextra and a.a. femoralis sinistra et dextra were investigatedby B-mode echography; 4 typical for calcium deposits periarticularregions of the body were checked by x-ray and visible skin calcificationswere registered in 40 patients (on HDT more than 3 months) for evalu-ation of calcification rate, comparing them with some biochemicalparameters: PTH, AP, Ca, Ca++, P and C-reactive protein (CRP).
Results: The study found a high percentage of vascular calcifications(VC) – 95%, and a low percentage of periarticular and skin calcifications– 3.3%. A significant correlation were found between PTH/AP (r=0.7,p<0.001), PTH/VC (r=0.51, p<0.001), PTH/Ca++ (r=0.40, p<0.01) andPTH/CRP (r=0.39, p<0.01) as well as between CRP/VC (r=0.38, p<0.01)Conclusion: The study suggests an influence of secondary hyper-parathyroidism and existing inflamatory status on vascular calcifica-tions in dialysis patients, but no relation of both factors to periarticu-lar and skin calcium deposits, that would require a different kind oftherapy.
RENAL OSTEODYSTROPHY (ROD) IN PERITONEAL DIALYSIS (PD)
AND HEMODIALYSIS (HD) PATIENTS-WHAT IS DIFFERENT?
D. Yonova1 and P. Dukova2 Dialysis Clinic1, Central Lab2, Medical University Hospital "Alexan-drovska", Sofia, p-1431, Bulgaria Two general types of ROD are recognized in patients (pts.) on dialysis,excluding the third, mixed one - high bone turnover ROD (HBT) andlow bone turnover ROD (LBT). When the "golden standard" – bonebiopsy – could not be used, a complex of serum markers quite suc-cessfully replace it: intact PTH, bone alkaline phosphatase (BAP),osteocalcin (OC), reflecting bone formation rate and ‚-crosslaps (BC),reflecting bone re-absorption. The study tries to compare the prevalence of HBT or LBT in 15 pts. onPD (7 males and 8 females) and 15 HD pts., (8 males and 7 females)more than 2 years on dialysis, all of them non-diabetic, registering their biochemical bone markers, above mentioned. The results showed aprevalence of HBT in patients on HD – in 11 of them – significantly high-er than normal PTH, BAP, OC and BC and oppositely – a prevalence oflower levels of PTH, BAP, OC and BC in 12 of PD patients. Interestingly2 patients on HD (but not any on PD) had low-normal PTH and higher‚-crosslaps (p<0.01), that probably may be a different subtype of LBT,recently described as "LBT-ROD with increased bone re-absorption".
The findings proved the difference of prevailing type ROD in HD andPD treatments and pointed on the importance of investigation and fol-lowing up each one of the dialysis patients, as HBT and LBT are notdefinitively the privilege of any kind of extra-renal purification method.
The existence of a different LBT subtype in HD pts. and lack of it in PDpts. may be due to the influence of the artificial HD materials on theproduction of cytokines, potent to increase bone re-absorption.
VALVE CALCIFICATIONS AND THEIR RELATION TO MYOCARDIAL
FUNCTION AND SOME RISK FACTORS IN HEMODIALYSIS PATIENTS
Georgiev M., Yonova D., Antonov S. and Kirijakov Z.
Dialysis Clinic, Med. Univ. Hosp "Alexandrovska", Sofia, p-1431 Bulgaria The aim of the study: To find some risk factors for development of car-diac valve calcifications and their relations to myocardial function inpatients on hemodialysis treatment. Methods: Conventional M-mode and B-mode echocardiography (Echo)and Pulse-doppler were made, accounting myocardial function andaorta valve calcifications (Ca-Ao), mitral valve calcifications (Ca-M) andtotal valve calcifications score (Ca-Ao+M) of 40 patient (21 males and19 females), mean age 56±13 years on haemodialysis treatment (HDT),mean duration 7.27±4.5 years. Arterial blood presure (ABP) and pulserate were also registered. Tests of serum levels of Ca++, P, AP, PTH andC-reactive protein (CRP) were compared to some myocardial functions(ejection fraction-EF; endsystolic stress - ESS; VpE/VpA), musclemass index (MMI), and valve calcifications rate. Results: Some significant correlations were found as follows: Ca++/Ca-Ao+M r=0.46, p<0.01; PTH/Ca-Ao+M r=0.43, p<0.01; EF/ESS r=0.81,p<0.01; EF/Ca-Ao+M r=-0.38, p<0.05; CRP/EF r=-0.4, p<0.01;MMI/MAP r=0.52, p<0.01; VpE/VpA : Ca-Ao+M r=-0.38, p<0.05;Age/Ca-Ao+M r=0.4, p<0.01; Dur.HD/Ca-Ao+M r=0.28, p<0.05;PTH/EF r=-0.22, n.s. Discussion and conclusions: The results prove the negative influenceof increased myocardial burden (ESS, ABP) on the left ventricular func-tion and on MMI. Close relations of disturbed mineral metabolism,PTH, inflamatory status (CRP), age and duration of HD with the rate ofvalve calcifications show that cardiac calcium deposits have multifac-torial origin. The study also suggests that valve calcifications areinvolved in the complex of risk factors, causing damage of the valvestructures and left ventricular dysfunction in HD patients. THE ILL CHILD AND HIS QUALITY OF LIFE
Michopoulou, A., Belesioti, B., Tampakaki, E., Papadopoulou, E.
Penteli Children's Hospital, Psychology Department8, Ippokratous str., 152 36 Palea Penteli, Greece This study aims to compare quality of life between three groups of chil-dren: a) hospitalized children at Penteli Children's Hospital b) childrenconsulting the different outpatient services (such as Pediatric,Endocrinology, Allergiology, Orthopedic, Child Development and Psy-chological sections) and c) a control group of schoolers. Children, agedbetween 6 and 14, were given a questionnaire of quality of life to fill.
The questionnaire is based on Kid-KINDL questionnaire for children(translated and standardized by Vidalis A. and Vidali L.E.). Fivedomains of quality of life were evaluated: somatic, psychological,social, family and school life. Hypothesis was confirmed that controlgroup had better quality of life than the other two groups of ill childrenand especially children with chronic illness. MANAGEMENT OF ANXIETY DISORDERS: DOES ROUTINE CLINICAL
PRACTICE MEET TREATMENT GUIDELINES?
Nestoris C., Dafoulis P., Argyropoulos Y., Rosis P., Simos G.
Community Mental Health Center, Central District, Thessaloniki,Greece Introduction: Quality in clinical practice is synonymous to effectiveclinical management, and effective clinical management correlatesdirectly to appropriate choice and application of disorder-specific treat-ment modalities according to unanimously accepted evidence-basedtreatment guidelines. Aim of the present study was to check the appro-priateness of offered treatment in the most common anxiety disordersat a CMHC, always according to the above rational.
Method: Subjects were 167 consecutive outpatients of our CMHC thatafter a careful clinical evaluation according to DSM-IV criteria werediagnosed as suffering from a common primary anxiety disorder (PanicDisorder without Agoraphobia-PD/ n=38, Panic Disorder with Agora-phobia-PDA/ n=57, Obsessive-Compulsive Disorder-OCD/ n=39, andGeneralized Anxiety Disorder-GAD/ n=33). Suggested allocation to psy-chotherapeutic management (Supportive Psychotherapy-SP, AnalyticPsychotherapy-AP, Behaviour Therapy-BT, Cognitive Behaviour Thera-py-CBT, Cognitive Analytic Therapy-CAT, Family Therapy-FT, and Cou-ples Therapy-COT) as well as adjunctive medication-MED (NecessaryMED-NMED or Optional MED-OMED) were taken into consideration.
Results: No patient was referred to FT or COT, only 2 patients were referred to AP, while the vast majority of patients were referred to BTand CBT. Concerning comparisons among individual diagnoses, PDAwas more frequently referred to CBT and BT (P<0,000 and P<0,05respectively) and less frequently referred to SP (P<0,000), OCD wasmore frequently referred to BT (P<0,000) and less frequently referred toSP (P<0,000), GAD was more frequently referred to CAT (P<0,000),while PD did not relate to any specific psychotherapy option. Concern-ing medication, OCD was more frequently referred to NMED, PDA wasmore frequently referred to OMED, whereas PD and GAD did not dis-criminate from other anxiety disorders in frequency of referral to eitherNMED or OMED.
Discussion: Although clinical picture is often complicated by second-ary, both Axis I and Axis II, diagnoses, presenting problem (primarydiagnosis) is the major factor in determining decisions for appropriatepsychotherapy and medication management. Present results seem tocorrespond to what is considered to be treatment of choice for specificanxiety disorders, ascertaining thus optimal treatment and possibleexcellence in clinical practice. PATIENT'S SATISFACTION AS A MEASURE OF QUALITY OF CARE
Theofanidis D1, Fitsioris F2, Fountouki A3, Rudolf G2 1Technological Educational Institute of Thessaloniki2Neurological ward, "PAPAGEORGIOU" General Hospital,3Neurosurgical ward, "AXEPA" General Hospital, Introduction: Consumer satisfaction is central to the strategy of mar-keting-orientated organizations such as hospitals because they serveas a central measure of measuring quality of care. As yet, no singlemethod has been widely accepted as the gold standard for measuringpatient's (consumer's) satisfaction. Some researchers have used indi-rect measures focusing on expectations, beliefs and attitudes, whileothers preferred a more direct methodology measuring patient's satis-faction or dissatisfaction levels.
Objectives: To describe the three main factors which define patient'ssatisfaction.
Results: Performance levels: when a patient seeks treatment theprovider can perform at various levels ranging from way below estab-lished standards to ideal (use of clinical protocols and managed care)consumer expectations: patient's expectations have a key role in deter-mining how satisfied patients are with he care they received as con-sumers who expect low quality service generally feel dissatisfied afterleaving hospital. consumer perceptions: as health care quality is so dif-ficult for patients to assess, hospital managers have an opportunity tiinfluence patient's perception of care quality. Conclusions: in order to provide the highest level of care, hospitalsneed to control both expectations and perceptions of treatment quali-ty as knowledge of actual and perceived treatment quality provides thenecessary information for designing programs to satisfy patients.
QUALITY OF CARE AND HEALTH ECONOMICS
Theofanidis D1, Fitsioris F2, Fountouki A3, Rudolf G2 1Technological Educational Institute of Thessaloniki2Neurological ward, "PAPAGEORGIOU" General Hospital,3Neurosurgical ward, "AXEPA" General Hospital, Clinicians are increasingly accepting a broad social responsibility asallocators and too often managers of scarce health care resources. Yet,in a quest for cost effectiveness we must not ignore questions of qual-ity. Thus, economists have to work close with clinicians, patients andthe general public to ensure that health care is delivered within a qual-ity environment by some degree of social consensus. Furthermore, weneed to explore the constrains within which society wishes health careto be provided. The two main models that prevailed the way health careis delivered are discussed as follows.
The traditional clinical decision model: In this model, the clinicianmakes decisions on the basis of "what is in the best interest" of thepatient. However, costs are seen as irrelevant in pursuit of the bestinterests of the individual. Many clinicians think that not only shouldany treatment that might reasonably be expected to do some good beprovided, but also there is a technological imperative to try even ifthere is no real prospect of benefit to the patient.
The traditional health economics model: In principle, economists tra-ditionally argue on a collective, rather than individual paradigm, whichis focusing on the relationship between costs to society as a whole andthe benefits to society as a whole. Therefore, the economist's priority issocietal well being.
QUALITY OF LIFE IN PATIENTS WITH ACUTE CORONARY
Uuskyla, M. Kaasik, E.
Department of Cardiology, Tartu University Clinics, L.Puusepa Str 8, EE-51014 Tartu, Estonia Objective: To describe the quality of life (QOL) and psychoemotionalstate in survivors from sudden cardiac arrest (SCA) and patients withacute myocardial infarction (AMI). Methods: 54 patients, successfully resuscitated from SCA, mean age58.4 years, in good Glasgow-Pittsburgh Cerebral Performance Cate-gorie, 72% males; 20 patients with acute myocardial infarction (AMI),matched for gender and age. Depression and anxiety was measuredwith self-report Emotional State Questionnaire EST-Q; vital exhaus-tion and fatigue during the last month before SCA or AMI event was measured by 21-item Maastricht Questionnaire; Medical OutcomesStudy Short Form SF-36 was used to validate health-related QOL.
Results: The mean score of the depression and anxiety subscales wassignificantly higher in victims of SCA and AMI patients. They sufferedconsiderably more frequently from vital exhaustion and fatigue beforeevent, compared to population control. Patients reported the impor-tance of physical symptoms, uncertainty of prognosis and decline inthe cognitive function.
"INNOCENT" DIETARY PROTEIN SUPPLEMENTS AND FOCAL
NODULAR HYPERPLASIA. SHOULD WE FORBID THEIR USE?
Karadimou Vasiliki, Kourou Eugenia, Genaridis Isaak, IatropoulosVasilios.
Department of Radiology, General Hospital of Veria, Greece,P.O. 59100OBJECTIVE: To reveal a possible correlation between dietary proteinsupplements considered as complements without side effects andbenign liver tumors such as focal nodular hyperplasia (FNH).
METHODS: A 29 years old patient was ultrasonographically examinedin our hospital after a car accident. US findings indicated FNH - thatdid not exist in previous US - confirmed by CT and MRI while liverbiopsy put definite diagnosis excluding malignancy.
RESULTS: The patient was a non-smoker athlete. His medical historywas free of any disease. He reported no use of alcohol, drugs or otherchemical substances. Exception was the use of oral supplements foralmost 2 years that he considered as natural complements used formuscle building. These products can be found mainly in gymnasticareas without prescription. CONCLUSIONS: FNH is a rare benign lesion that probably reflects a localhyperplastic response of hepatocytes to a vascular abnormality. FNHoccurs at least twice as frequent in females. A relationship with oral con-tra-ceptives has been demonstrated. Anabolic androgens, prescribedtherapeutically or abused, are known to cause liver neoplasms, primari-ly hepatocellular carcinoma, adenomas, FNH, cholangiosarcoma andangiosarcoma. Cases of carcinoma development in preexisting FNH havebeen reported. In literature, however, evidence for malignant transfor-mation is lacking. In our case, there is a strong indication that thesesupplements containing anabolic androgens in low doses were responsi-ble for FNH. We suggest that 1) further investigation is absolutely nec-essary since a growing number of athletes is using them 2) users shouldbe informed about the substances and the side effects and 3) these prod-ucts should be forbidden or at least not given without prescription.
FATIGUE, COGNITIVE DEFICITS AND QUALITY OF LIFE IN
MULTIPLE SCLEROSIS PATIENTS
Adamantia Dourouma, Ria Pita, Anastasia Efklides, GrigorisKiosseoglou, & Anastasios G. Orologas Aristotle University of Thessaloniki, Greece The purpose of this study was to investigate the relations of quality oflife (QoL) with attention, fatigue and demographic data in MS patients.
Seventy-seven patients (42 women and 35 men), aged 17-67 years,were administered the QOLIE-89, Fatigue Impact Profile (FIP), FatigueSeverity Scale (FSS), Test of Everyday Attention (TEA), and STROOPTest. Hierarchical regression analyses were conducted having asdependent variables the factors of QOLIE-89 and independent vari-ables FIP, FSS, TEA and STROOP. Gender, type of MS, duration of ill-ness, years of education and marital status were used as control vari-ables. The results revealed that illness duration affected the "visualselective attention performance" factor of TEA and "physical function"of QOLIE-89. Type of MS, "switch of attention or cognitive flexibility"(TEA), and "cognitive fatigue" (FIP) affected the "energy/fatigue" ofQOLIE-89. Marital status affected "relapse worry" of QOLIE-89through the "switch of attention or cognitive flexibility" and the "visualselective attention" (TEA), and the "physical and social fatigue" (FIP).
Furthermore, marital status via "social fatigue" of FIP affected "med-ication effects" of QOLIE-89. Years of education through "alertness"(TEA) and "cognitive fatigue" (FIP) affected "overall quality of life".
Besides, "alertness" (TEA) and "physical fatigue" (FIP) affected the"role-limitations emotional" of QoL, as well as "switch of attention orcognitive flexibility" (TEA) and "cognitive fatigue" (FIP) associated with"attention-concentration" of QOLIE-89. There were no associationsbetween QoL, fatigue, and STROOP. The results of our study, in accor-dance with current literature, suggest that fatigue has significantinteractions with QoL, and this is related to demographic data andattention in MS patients.
STUDY OF DIAGNOSTIC COST OF LIVER SOLID EXPANSIVE
LESIONS IN A PROVINCIAL HOSPITAL
Kourou Eugenia, Karadimou Vasiliki, Genaridis Isaak, SarafopoulosApostolos, Iatropoulos Vasilios. Department of Radiology, General Hospital of Veria, Greece. P.O. 59100 AIM: The calculation of cost when CT and MRI are required in solidexpansive lesions of the liver, in a provincial hospital that does nothave available CT and MRI. MATERIAL – METHOD: Eighty three patients were studied and sep-arated in 3 groups depending on the radiological method used (GroupA: only US, group B: US plus CT, group C: US, CT plus MRI). Then weproceeded to calculation and comparison of hospitalisation time andcost between groups. Final diagnosis was reached by liver biopsy in allcases. RESULTS: Hospitalization time was doubled in group C compared togroup A while average hospitalization cost was tripled mainly due tothe need for transfer to other hospitals for CT and MRI. Cost per dayincreased up to 44 % and 89 % in the second and third group respec-tively, while cost per day per patient was found 4,5 times higher in thethird group compared to group A. CONCLUSION: For the treatment of liver solid expansive lesions finaland definite diagnosis is required that can be achieved only by liverbiopsy. In a provincial hospital without available CT and MRI, we con-fine their diagnostic help to cases with absolute contraindication ofbiopsy. The dramatic increase of hospitalization cost, the extension ofhospitalization time that affects the patient's quality of life, the socialrepercussions and inconvenience of patients render the use of MRIrather prohibitory, while CT is considered essential in the diagnosticapproach for disease classification. Thus we suggest the followingalternative protocol: "In solid expansive lesions of the liver we advancedirectly to liver biopsy in a provincial hospital that does not allocate CT and MRI ".
QUALITY OF LIFE FOR PATIENTS IN THE FINAL STAGES OF
Gatos K., Bourelia St., Papazova M., Karachaliou F., Paxinou P.,Repana O., Gatos G-Th.
Neurological clinic SAINT GEORGE The aim of this paper is to present the ways of care that improve qual-ity of life of patients in the final stage of dementia. At the same time topoint out that from 1981 to 2003 there is an increase rate of demandsfor beds (from 5% to 50%) for demented patients.
Patients are classified in the final stage of dementia according thescore they achieve in the Mini Mental Test but in some of them the testcannot be carried out.
The most frequent co-existing health problems were: diabetes 13 indi-viduals, hypertension 7, cardiovascular disorders 14, serious anemia7, fractures of the femoral neck 7, history of alcoholism 3, decubitus11 individuals (in 3 extended).
We describe the ways of intervention such as medical attention, nurs-ing care, physiotherapy and administration of drugs, to help thesepatients. It, s our belief that providing effective care in the specialized depart-ment not only improves the quality of life of these patients but also prolongs the time they are expected to live. Furthermore we think thatrelieves the family from burden and guilt whereas at the same timethey feel that their relatives are properly taken care. QUALITY OF LIFE ISSUES PERCEIVED FROM ANXIETY-DEPRESSIVE
S. Tsilikas, G. Mitregas, A. Mpozis, Cleopatra Fylactou, A. Vidalis Psychiatric Department, Hippocratio General Hospital, Thessaloniki The goal of our study was to determine first of all the issues that apatient population sample believe are keys for their "quality of life" andsecondly how these issues are perceived from the general population.
Forty-one psychiatric patients of our Out Patient Department and ofHealth Centers with anxiety-depressive disorder in the stage of totalremission, recorded the factors they believe have to deal with the issueof "quality of life". From the written free texts that were collected, keywords and phrases were distinguished, put into groups-categories andfinally used to form forty-four items, which in a random order consti-tuted the "questionnaire".
Subsequently, the above sentences were given to groups of people(hospital doctors and Health Centers, nursing personnel, para-med-ical, administrative and auxiliary hospital personnel, teachers, univer-sity students, public, municipal and private employees, freelancersetc.), of the general population. The results of the 209 questionnairesthat were collected were compared, analyzed and then interpretedaccording to theoretical records. SUICIDAL BEHAVIOR IN A SAMPLE OF ADOLESCENTS WHO VISIT
MEDICAL UNITS OF A GENERAL HOSPITAL
Asteriadou F., Kouri A., Christianopoulos K.
Psychiatric department of child and adolescent, Hippokratio G.H.,Thessaloniki Objective: to investigate the psychopathology of adolescents and theirparents, plus the structure of the family environment in relation withthe suicidal behavior.
Subject-Methodology: the subjects were drown from the clinic, the liai-son and the outpatient department of the Psychiatric department ofchild and adolescent, Hippokratio G.H. We examined 20 adolescents inthe age of 13-18 years, between January 2000 to December 2003.
Information was collected by means of semistructured interviews of adolescents and their parents. We examined the following parameters:demographics, individual psychopathology, family history of psychi-atric disorders, quality of support environment, alcohol and drugabuse, characteristics of the suicide attempts and existence of stress-ful factors. Results: all the adolescents suffered from intense psychopathology (mood disorders, anorexia nervosa, personality disorders, sexualabuse, mental retardation, gender identity disorder ). 2 3 of the sam-ple had positive or possible family history for psychiatric disorders. 13of 20 adolescents had inadequate support environment and 3 of themlived in a institution. Stressful life events came before every suicideattempt (family conflicts, loss, financial problems, abuse ). Occasion-ally substance and alcohol abuse was referred by 3 of the adolescents.
Conclusion: therapeutic treatment of the individual psychopathologyof the adolescents is very important. Moreover, the opportune inter-vention in the disturbed environment is necessary for the preventionand decrease of suicidal behavior among youth.
QUALITY OF LIFE (QOL) AMONG GREEK CHILDREN WITH CYSTIC
FIBROSIS- COMPARISON BETWEEN CAREGIVER AND PATIENT
E. Hatziagorou1, A. Vidalis2, J. Tsanakas1 and the DISABKIDS Group.
1Pediatric Pulmonology Unit, Aristotle University of Thessaloniki,Greece, 2Phychiatric Unit, Hippocratio General Hospital, Greece. Background: Considerable progress has been made over the past twodecades in defining and measuring Health-Related –Quality of Life(QQL). There is increasing evidence that these measures provide objec-tive information on the impact of a chronic illness and it's treatmenton a patient's daily activities and life. Aim: To assess the QOL in chil-dren with Cystic Fibrosis (CF) and to make comparisons betweenpatients and their parents on the effect of CF on their QOL. Patientsand methods: Twenty-nine children with CF and their parents usedthe well-validated DISABKIDS Questionnaire (including a chronicgeneric and a disease- specific questionnaire for CF). The childrengroup, aged 8-16 years, comprised of all grades of disease severity.
Results: There was a strong correlation between the scores of the chil-dren and their parents in the generic and the disease- specific ques-tionnaire (of all of the domains: independence, limitation, emotion,social exclusion, treatment, impact) (p<0,05). There was a poor corre-lation only between the social inclusion score of the children and theirparents, with parents having higher scores; children thought that theyhad a better family and school life while their parents didn't share thatopinion. Conclusion: A strong relationship between caregiver andpatient perceptions of CF Quality of Life has been found. Both of theseparameters should be taken under consideration in order to monitorCF control adequately.
UVULOPALATOPHARYNGOPLASTY WITH ULTRASONIC HARMONIC
SCALPEL IN PATIENTS WITH SNORING AND MILD OBSTRUCTIVE
SLEEP APNEA SYNDROME
Petropoulos I, Konstantinidis I, Triaridis Ath, Karagiannidis K, Kont-zoglou G.
ENT Department, Hippokratio Hospital, Thessaloniki, Greece. OBJECTIVE: To evaluate the efficacy of harmonic scalpel in the surgi-cal management of snoring and mild obstructive sleep apnea syndrome(OSAS).
MATERIAL-METHOD: This is a prospective study of five patients withsnoring and ten patients with mild OSAS who underwent uvu-lopalatopharyngoplasty within the last six-months of 2003 in our ENTdepartment. Preoperative evalution included nasendoscopy with flexi-ble endoscope and Muller's maneuver, and polysomnography. Allpatients completed a Quality of Life questionnaire. Single snorers, hada preoperative mean snore index (SI)102,3 and those with mild OSAShad a preoperative SI 65,8 and Apnea/Hypopnea index (AHI) 20,5.
All patients underwent uvulopalatopharyngoplasty (including tonsil-lectomy) with ultrasonic harmonic scalpel under general anesthesia.
Postoperatively no major complications were observed and all patientshad an uneventful recovery.
RESULTS: The use of harmonic scalpel offered a clear surgical fieldwith minor hemorrhage. Patients did not reported excessive postoper-ative pain and the mean used quantity of paracetamole in the postop-erative period in the Hospital was 2,4 gr/day. In a follow up appoint-ment three months later, 12 patients returned and had the previousmentioned evaluation. The majority of patients had significantimprovement of their symptoms according to their subjective opinion.
Polysomnography results showed a significant reduction of the meanSI in both groups of patients (snorers SI:22,7 and OSAS patientsSI:15,3). There was also improvement in AHI in patients with mildOSAS(mean postoperative AHI:6,9 ).
CONCLUSION: Ultrasonic uvulopalatopharyngoplasty is an alternativesafe and effective procedure for the treatment of snoring and mildOSAS when preceded by careful selection of the candidates.
LATE ADVERSE EFFECTS AFFECTING QUALITY OF LIFE AFTER
HEMOPOEITIC STEM CELL TRANSPLANTATION
Somali M.1, Mpatakoias V.1, Kalogiannidis P.2, Fassas Ath.2,Avramides Av.1 1Endocrinology Department, Hippokrateion General Hospital Thessa-loniki, Greece 2Haematology Department, ‘G. Papanikolaou' GeneralHospital, Thessaloniki, Greece Introduction: As the number of survivors after allogeneic or autologoushemopoeitic stem cell transplantation (HCT) constantly increases,the issue of providing a good quality of life has become extremely sig-nificant. Endocrinopathies such as thyroid and gonadal dysfunctiondue to the toxicity of the conditioning regimens impose a strong nega-tive impact on quality of life post HCT. Adverse effects such ashypothyroidism, hypogonadism, reduced reproductive ability and sex-ual function and osteoporosis have to be considered.
Objective: The objective of our study was to observe the incidence of pos-sible endocrinopathies affecting the quality of life in our study popula-tion consisting of adult men and women having recently undergone HCT. Material and methods: In our series we included 72 patients (41females and 31 males) at a mean time of 1,5 years post HCT (range 0.2– 9.8 yrs), with a mean age at the time of examination 32,6 years (SD10,0) and a mean age of 30,4 (SD 9,7) years at the time of HCT. Nogonadal or thyroid dysfunction was reported in any of the patientsprior to HCT. Thyroid and gonadal function were evaluated by deter-mination of basal levels of FSH, LH, testosterone (in men),TSH , FT4and functional tests of the hypophysis - gonadal and the hypophysis -thyroid axes. Determination of bone mass density by DEXA was alsocarried out in all patients. The work up was given at the beginning ofthe study and annually thereafter for two consecutive years.
Results: Clinical hypergonadotrophic hypogonadism was observed in33% and subclinical hypogonadism in 22% of our male patients.
Defective spermatogenesis as indicated by high levels FSH and normallevels of LH was observed in up to 82% of male patients. Hyperg-onadotrophic hypogonadism indicative of gonadal failure was alsoobserved in the majority of our female patients (97%). Osteoporosiseither as a result of hypogonadism or chronic corticoid therapy wasobserved both in males and females (58% and 66% respectively). Overthypothyroidism was observed in 13% of our study population ( 8%males and 5% females), whereas subclinical hypothyroidism wasobserved in 16% of our study population (11% males and 5% females). Conclusion: Quality of life post HCT is significantly compromised bythe incidence of endocrinopathies as a result of the toxicity of the con-ditioning regimens. Premature gonadal failure, hypogonadism,hypothyroidism, reduced reproductive ability and premature osteo-porosis are some of the adverse effects that have to be seriously con-sidered by the medical community and efforts should be made toovercome these "handicaps" in order to provide the highest possible quality of life to HCT survivors. ROLE OF THREE-DIMENTIONAL COMPUTED TOMOGRAPHY (3D-CT)
IN THE STUDY AND MANAGEMENT OF CRANIOSYNOSTOSIS
G.GrolliosÅ, J. AnagnostopoulosÇ, I. KazantzidouÅ, D. DaravigasÅ, M.
SiopiÅ, G. TerzisÅ, K. TsarouchasÅ, K. TsinoglouÅ ÅA_ Radiology and Imaging Department, Ippokrateio General Hospital,Thessaloniki, Greece Ç2nd Neurosurgery Clinic, Aristoteleio Universityof Thessaloniki, Greece Purpose: to demonstrate the role of three-dimentional computedtomography (3D-CT) in the diagnosis and study of the various types ofcraniosynostosis, and to help the correct management of the disease.
Materials and methods: B32 children, aged from 24 days to 5 years,with a clinical or radiological indication of craniosynostosis, were ref-ered for a helical CT scan of the skull, from January 2002 to Decem-ber 2003. The examination was performed with the use of a PhillipsTomoscan SR7000 scanner. A 1.5mm collimation and a pitch of 2 wereused, with an overlapping of the axial images every 2mm. A three-dimentional reconstruction of the acquired axial images was after-wards performed in bone window settings.
Results: B In every case, the diagnosis of craniosynostosis was clear.
In particular, 12 children (38%) exhibited scaphocephaly; 10 (31%)exhibited plagiocephaly; 3 (9%) exhibited brachycephaly; 3 (9%)trigonocephaly; 2 (6%) oxycephaly; and 2 (6%) microcephaly. Con-comitant intracranial (brain) pathology was revealed in 8 cases (3 chil-dren presented hydrocephalus and 5 showed brain atrophy). The sur-gical repair was planned based on the results of the three-dimention-al CT reconstructions.
Conclusion: In conclusion, we can claim that three-dimentional com-puted tomography, combined with classic axial CT imaging, contributesto the diagnosis of the type of craniosynostosis, providing detailed infor-mation about the extent of the disease and revealing also possible coex-isting intracranial abnormalities; finally, 3D-CT can be used as a basefor the surgical planning of patients with craniosynostosis ROLE OF SPIRAL COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF
ACUTE PULMONARY EMBOLISM
G.Grollios, I. Kazantzidou, D. Daravigas, K. Tsinoglou, T. Fidanis, G.
Mihailidou, V.Voultsinos, H. Geranou A_ Radiology and Imaging Department, Ippokrateio General Hospital,Thessaloniki, Greece Purpose: The demonstration of the value of spiral computed tomogra-phy (SCT) for the prompt diagnosis of acute pulmonary embolism.
Materials and methods: Materials: Eight patients (6 men, 2 women,mean age 62.1) with a clinical suspicion of acute pulmonary embolismwere submitted to a SCT examination of the chest, between Januaryand December 2003. Only one patient had previously undertaken aventilation-perfusion scintigram, which was of high probability for pul-monary embolism. None of the patients was subjected to a pulmonaryangiography. A post-thrombolysis follow-up SCT scan was performedin two patients. Methods: The CT scans were performed with the use of a PhillipsTomoscan SR7000 scanner. The chest was first scanned with 10mm-thick contiguous slices from the lung apices to the diaphragm. Then,a single-breath-hold spiral CT scan was performed from the level of theaortic arch to the lower pulmonary veins, using 3mm collimation anda pitch of 1. Scanning was initiated with a time delay of 15 sec afterthe intravenous injection of 100ml of iodine contrast material, with theuse of an automated injector at an injection rate of 4 ml/sec.
Results: All patients demonstrated multiple emboli as filling defectswithin the lumen of the opacified pulmonary arterial branches. Morespecifically, four patients showed emboli into 2nd order branches(right or left pulmonary artery), seven showed emboli into 3rd orderbranches (lobar) and four showed emboli into 4th order branches (seg-mental). No emboli in subsegmental or more peripheral branches couldbe identified. Concomitant findings included the presence of pleuraleffusions (five patients), oligaemic low-attenuation areas of the lungparenchyma (one patient) and pleural-based wedge-shaped opacities,indicative of pulmonary infarcts (one patient). SCT also disclosedunderlying lung pathology such as pneumothorax (one patient) andmultiple lung metastases (one patient). The two patients that under-went a post-thrombolysis follow-up SCT scan showed lysis of theemboli and reperfusion of the oligaemic parenchymal areas.
Conclusionsl: In our experience, spiral computed tomography can beused as a fast, noninvasive method for the prompt diagnosis of acutepulmonary embolism in the central pulmonary branches (up to thesegmental level), even without the need for a prior scintigraphic study.
THE IMPACT OF ANXIETY ON THE PERCEIVED SATISFACTION
FROM QUALITY OF LIFE IN SCHIZOPHRENIC AND
S. Kaprinis, A. Konsta, S. M. Kandyli, M. Nakou, D. Kandylis.
3rd University Psychiatric Department of the Aristotle University ofThessaloniki.
2nd University Psychiatric Department of the Aristotle University ofThessaloniki. Introduction: There has been an ever increasing interest in the meas-urement of the quality of life, initially in the field of general health andthen also in that of mental health, in order to assess personal prob- lems, to meet the needs of groups of mentally ill patients, for researchpurposes as well as for the planning of adequate services concerningmental health in the community. The measurements contain and cor-relate demographic as well as clinical factors.
Purpose: The purpose of our study is the assessment of the possibleinfluence of anxiety on the perceived satisfaction from quality of life inschizophrenic and schizoaffective patients.
Material: Fifty three (53) patients have been investigated, 27 male and26 female, with an age average of 35.8 years. Of these patients, 42were schizophrenics (Group 1) and 11 were schizoaffective (Group 2),according to the DSM-IV diagnostic criteria. Twenty three (23) patientswere living alone, 30 with their families. Of the investigated patients13.2% had gone to school for 6 years, 9,4% for 9 years, 32.1% for 12years, and 53% had a higher education.Twelve (12) patients had anaccompanying chronic somatic illness. Method: The patients have been assessed using the WHOQoL-Brefscale for the measurement of the quality of life, as well as with thePANSS, MMSE and HARS scales. Patients with a MMSE score ≤23 wereexcluded from the study, as were patients with neurodegenerative dis-eases, or addiction to alcohol or illegal psychoactive substances.
Results: In our subjects, anxiety seems to be connected with a lowerquality of life, whereas no statistically significant correlations arefound with the positive symptoms scale, the negative symptoms scaleand general psychopathology scale.
Conclusion: The results lead us to the conclusion that anxiety has asignificant impact on the quality of life in schizophrenic and schizoaf- fective patients. SATISFACTION FROM QUALITY OF LIFE IN STUDENTS OF THE
ARISTOTLE UNIVERSITY OF THESSALONIKI: THE IMPACT OF
Kaprinis S, Kandylis M S, Filippaki E, Kandylis D 3rd University Psychiatric Department of the Aristotle University ofThessaloniki Introduction: In Medicine, the interest on the investigation of satisfac-tion from quality of life stems from the definition of health by theW.H.O. "as a condition of full physical, mental and social well-beingand not just the absence of disease or handicap". Quality of life con-stitutes an important variable that needs to be taken into account inorder to organize social mental care systems for the community, andin our case, for the student population of the Aristotle University ofThessaloniki (A.U.Th.).
Purpose: The purpose of our study is the assessment of the possibleimpact of certain demographic factors and their correlation to the per-ceived quality of life in a group of students at the A.U.Th.
Material: Two hundred and fifty (250) students at the A.U.Th. have been investigated, 127 male and 123 female. Of these students, 154came from an urban environment, 78 from a semi-urban environmentand 18 from a rural environment. 37.6% of the students were livingalone, 32.8% with their families and 29.6% with another/other per-son(s). A percentage of 16.4% of the students were working along withtheir studies and 1.2% was being treated for a chronic physical illness.
We investigated students in the entire range from the 1st to the 7thyear of their studies. The students investigated were equally distrib-uted in five categories of schools: 1) Medical school, 2) TechnicalUniversity schools, 3) Schools of Law, Political Sciences and Finances,4) Philosophical school, and 5) Schools of the Exact Sciences.
Method: All students have been assessed using the WHOQoL-Brefscale, which is a reliable and suitable cross-cultural tool for the meas-urement of the perceived satisfaction from quality of life. The scale con-sists of 4 units assessing: 1) physical condition, 2) psychological condi-tion, 3) social relationships, and 4) living conditions in the environment. Results: At first we examined whether the 5 groups of students werecomparable between them by performing the One-Way ANOVA and theTurkey HSD statistical analysis criteria. We found out that the 5groups were comparable between them where sex, original home envi-ronment, living conditions, and the existence of chronic physical ill-ness were concerned, whereas there were statistically significant dif-ferences where work and years of study were concerned. We then pro-ceeded to ascertain the possible affinity of the demographic variableswith the 4 units of the WHOQoL-Bref scale. By using the Spearmanrho criterion we found out that: 1) the students' sex, original homeenvironment, and the existence of chronic physical illness have a sta-tistically significant correlation with the 1st unit, 2) the students' sex,living conditions and the existence of chronic physical illness have astatistically significant correlation with the 2nd unit, 3) the students'original home environment has a statistically significant correlationwith the 3rd and 4th units, and 4) there is no statistically significantcorrelation with the students' University school.
Conclusion: The perceived quality of life in the group of students that weinvestigated depends on the students' sex, original home environment,living conditions, and the existence of chronic physical illness. It does not depend, however, on the content and difficulty of their studies.
QUALITY OF LIFE (QOL) AMING GREEK CHILDREN WITH ASTHMA-
COMPARISON BETWEEN PARENT AND CHILD PERCEPTION OF QOL
E. Hatziagorou1, A. Vidalis2, J. Tsanakas1 and the DISABKIDS Group.
1Pediatric Pulmonology Unit, Aristotle University of Thessaloniki,Greece, 2Phychiatric Unit, Hippocratio General Hospital, Greece. Background: Health-Related –Quality of Life (QQL) has became anessential part of health outcome in chronic disorders. QOL measure-ment is important in determining the impact of asthma and its treat- ment on everyday life. Aim: To assess the QOL in children with asth-ma and to compare the QOL scores achieved by children with the viewsof their parents on the effects of their child's asthma on family life.
Patients and methods: Thirty-eight children with asthma and theirparents used the well-validated DISABKIDS Questionnaire (includinga chronic generic and a disease- specific questionnaire for asthma).
The children group, aged 8-16 years, comprised of all grades of diseaseseverity. Results: There was a poor correlation between the scores ofthe children and their parents in the generic questionnaire (p<0,05),but they both had similar scores in the asthma-specific questionnaire.
Parents had higher scores in independence and social inclusion thantheir children, while children had higher scores in physical limitation.
Parents thought that their children had a better family and school lifeand that they were more independent that what their children thought.
Children thought that they had less physical limitation; they probablyunderestimated their symptoms. Conclusion: It is important to recog-nize that there may be little relationship between the concerns of thechild regarding his or her asthma, and the burden on the family-life,as reported by the parent. This recognition may affect treatment plan-ning with the family and may be taken into account during consulta-tion with the patients or with the caregivers.
EUROPEAN APPROACH TO MEASURING QUALITY OF LIFE IN
CHILDREN WITH CHRONIC CONDITIONS - THE DISABKIDS
Monika Bullinger, Silke Schmidt, Corinna Petersen, Holger Muehlanand the DISABKIDS Group Institut for Medical Psychology University Clinics Hamburg-Eppendorf,Hamburg, Germany Chronic conditions in children and adolescents pose a challenge bothto the young patients as well their families. To better understand howa chronic conditions might affect well-being and functioning, self-report of children and adolescents as well as a proxy report by parentsare necessary. Although quality of life research in children has alwaysbeen confronted with very specific problems such as the developmen-tal change over the age span and the value of self-report, severalinstruments to measure the Quality of Life (QoL) of children and ado-lescents as well as that of their families have been developed recentlyand are increasingly employed. However, most instruments are avail-able only in one language or are designed to measure quality of life inonly one health condition.
Within the European DISABKIDS-project, an attempt was made todevelop and test a set of instruments for quality of life assessment andchildren/adolescents as well as their parents in seven countries, threeage-groups of children (4-7, 8-12, 13-16) and for the following chronicconditions: asthma, cystic fibrosis, diabetes, epilepsy, arthritis, cere- bral palsy, and atopic dermatitis. After a pilot phase, in which theinstrument-set was developed (using focus groups and item writing) aswell as psychometrically pretested, it was included in a larger fieldstudy with 1600 children and families from the participating countries.
The modular structure of instrument, including both chronic genericassessment (tapping at the experience of having a chronic as such as)as well as a disease specific part (in which questions are related to thespecific health condition) is described. For very small children, aninterview version is used, while for older children self-reported ques-tionnaires are employed, as it is the case for parents of all children. Selected results of the field-study will be presented in terms of a briefoverview over the psychometric properties of the newly developed tool-set, and with regard to the distribution of quality of life evaluationswithin the different conditions as well as the relationship betweenquality of life and selected parameters such as clinical characteristics,socio-demographic and psycho-social determinants. Results from the DISABKIDS-project will be discussed in reference tothe growing literature on quality of life assessment in paediatricresearch a clinical practice.
RISK FACTORS AFFECTING TEN YEAR KIDNEY GRAFT SURVIVAL
G. Vergoulas, C. Tasiopoulou, A. Angelou, Gr. Miserlis, I. Katsara, V.
Papanikolaou, K. Ioannou, A. Avdelidou, G. Sakellariou Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki,Greece Background: One of the main reasons for the long patient – waiting listfor kidney transplantation is the loss of the allograft. Fifty per cent ofthe kidney allografts are lost 10 years after transplantation. The aim ofthis study was to investigate the factors that may affect long – termkidney, more than 10 years, graft survival. Patients and methods: Among 293 transplants performed from1.1.1987 to 17.12.1993, eighty-five had > 10 year graft survival (groupA) and eighty-nine had > one year and < 10 year survival (group B). All recipients received triple or quadruple sequential immunosuppres-sion (steroids, azathioprine, cyclosporine, ALG). We compared the twogroups of patients as far as their the body weight (BW), systolic anddiastolic blood pressure (SBP, DBP), serum creatinine (Scr) measuredin the 7th, 15th posttransplant day, 1st, 3rd, 6th month and thenyearly up to the 10th posttransplant year. Also the differences on coldischemia time (CIT), panel reacting antibodies (PRA), blood transfu-sions (BT), delayed graft function (DGF), acute rejection (AR), donorage, graft origin, HLA matching, donor and recipient sex were investi-gated. Repeated measures analysis, paired, independent t test andnon-parametric tests as well as descriptive statistics were used for sta-tistical analysis. Results: Scr levels at six months and one year after renal transplanta-tion (RT) were statistically significantly (ss) lower in group A compared to group B (1.42±0.36 mg/dl / 1.57± 0.54 mg/dl and 1.39±0.32 mg/dl/ 1.62±0.54 mg/dl, p: 0.04 and 0.002 respectively), SBP was ss lowerfrom the first to the sixth posttransplant year (p: 0.011) in group A,PRA were ss higher before transplantation in group B (p: 0.006) andAR episodes recorded in group B were 62.9% and in group A 33.7% (p:0.001).
Conclusions: From the variables measured we conclude that factorscharacterizing > 10 year graft survival are Scr levels < 1.5 mg/dl at theend of the first year, low frequency of AR, low PRA levels before RT andlow systolic blood pressure.
Gold Award Prize CLINICAL OUTCOME AND PATIENTS' SATISFACTION AFTER
SIMULTANEOUS BILATERAL BREAST RECONSTRUCTION WITH
FREE TRANSVERSE RECTUS ABDOMINIS MUSCLE FLAP
Laszlo Kovacs1 MD, Nikolaos A. Papadopulos1 PhD, Samir A. Ammar1MD, Markus Klöppel1 MD, Peter Herschbach2 PhD, Gerhard Heinrich2PhD, Edgar Biemer1 PhD 1Department of Plastic and Reconstructive Surgery, Klinikum rechtsder Isar, Technical University Munich2Institute and Outpatients Clinic for Psychosomatic Medicine, Psy-chotherapy and Medical Psychology, Klinikum rechts der Isar, Techni-cal University Munich A review was performed on 34 patients who underwent simultaneousbilateral breast reconstruction with a free TRAM flap between 1988and 2001. Long-term outcome and patients' satisfaction wereassessed. Flap complications affected 13 of 68 flaps (19.1%). Anasto-mosis revision was needed in 6 cases (8.8%), the salvage rate being50%. The rates of total and partial flap losses were 4.4% respectively1.5%. Bilateral flap loss did not occur. 4 out of our 34 patients devel-oped donor site complications (11.7%), with wound healing problemsbeing the most common (5.8%). Most of the patients were satisfied withtheir decision to have had breast reconstruction with free TRAM, 91%would choose the same operation again and would recommend thisprocedure to other patients. The patients felt an improvement in theirsexual life (20.8%), which, however, was minor to improvements theyreported concerning their social life (37.5%) and life in general (50%).
Every effort has been made to faithfully reproduce the abstracts as submitted. Howev-er, no responsibility is assumed by the organizing committee for any injury and/or dam-age to persons or property as a matter of products reliability, negligence or otherwise, orfrom any use or operation of any methods, products, instructions or ideas contained inthe material herein. Due to the rapid advances in the medical sciences, we recommendthat independent verification of diagnoses and drug dosages should be made. Speach at the OPENING CEREMONY by
Prof. J. Tzafettas
NIKOLAUS DUMBA (1830-1900)
After the fall of Constantinople ÈÓ 1452, the capital of the Byzantine empirerenamed later on as Istanbul, a number of Greeks sought refuge abroad,mainly in Italy and Venice in particular, where the interest in studying phi-losophy and literature continued. The contribution of these Greek scholarsand intellectuals in establishing the Renaissance is beyond doubt, as is theirimportance for the transition from the barbaric middle ages to the modernEuropean civilization. Vienna later on became the epicentre of their com-mercial and intellectual activities. Significant treaties between Europeanstates and the Ottoman empire (i.e. the treaties of Carlovic in 1699 andPazarevac in 1718) gave the opportunity to a large number of Greeks fromMacedonia, Thessaly, Ipeiros and Asia Minor to leave their birthplaces andmobilise themselves mainly within the wide borders of the Austrian andOttoman empires. Here they successfully established prosperous and wellorganized communities and prevailed as merchants along with Serbs, Arme-nians and Jews in a productive rivalry with their counterparts the Italians,Swiss and Germans. In theirnew homeland they wereallowed to preserve their nation-al and religious identities.
Apart from their most impres-sive economical achievementsin a free environment, many ofthem succeeded in becomingdistinguished members of theirnew societies. Among them wasthe Dumba family which settledin Vienna where there was adynamic Greek community, thestrongest outside Greece acountry then still under Turkishoccupation. These inspired Makart' s room in the Dumba Palais in Vienna.
Greeks never forgot their country A popular meeting place for eminent people of arts, pol-itics and economy. It was classified as one of the most of origin which they supported attractive spots of Vienna.
with great enthusiasm, while itwas still struggling for independence. The aim of this presentation isto make known to our, andfuture, generations mainly inAustria and Greece, one of themost outstanding personalitiesof the Viennese society in thesecond half of the 19th century.
Considering the unparalleledachievements of this exceptionalman, this is only a humble effortto somehow acknowledge hisgreat contribution to humanity, "Meeting at Nicolaus Dumba" encourage further research and A historical picture by Hans Temple (Museum of histo- promote his deserved historical ry in Vienna). Nicolaus Dumba in his Palais (touchingMakart's mini statue) surrounded by all eminent per- sonalities who shaped New Vienna.
This presentation is derived from the recently published illustrated biography of Nikolaus Dumba, the enthu-siastic Viennese who dominated in imperial Vienna at the peak of its glory,mostly in cultural life, but also in politics and the economy, among others. Referring to Dumba, Polychronis Enepekides, the recent professor of historyin Vienna, wrote characteristically: «…in the world capital of music, Vienna,nobody else influenced the developments in the field of music, as he did…». The grandeur of Dumba is also well reflected in the words of his contempo-rary professor Victor Tilgner, the sculptor ofMozart's monument. In 1886 he wrote to him: « …today in our empire nobody deserves the title of‘your Excellency', more than you do…».
His contribution to the erection of many of the out-standing public buildings in Vienna in the secondhalf of the 19th century, like the Musikverein andthe Parliament, as well as most of the statues in thecenter of the capital of the Hapsburgs, was secondto none. Referring to the Musikvereins-Gebäude,the Eldorado of classic music in Vienna, Dr Biba,the present director of the archives of theGesellschaft der Musikfreunde, pointed out recent-ly: «…without Dumba this building wouldn't havebeen standing…those who enjoy the concerts in ittoday, should express their gratitude to him…».
In 1896, following the unveiling of Mozart's statue, to which Dumba played a protagonistic role, the The erection of this monu- emperor Franz Josef appointed him, to a top posi- ment was the result of Nico-laus Dumba initiatives.
tion as his personal adviser.
Without Dumba we would Dumba was a great admirer of Schubert's. In an have known very little aboutthis great musicians.
honorary publication for Dumba and following an Dumba donated his collec- exhibition in the Rathaus about his life, during the tion of Schubert' s manu- Schubert's year celebrations in 1997, Dr. Hervig scripts invaluable to the cityof Vienna.
Wuertz, the library director of the city of Vienna,stated: "Without the Dumba's-Schubert collection, we would have knownvery little about this famous musician…" . Nikolaus Dumba donated thisinvaluable collection, the largest in the world, to his beloved city of Viennaand in 2001 it was entered in the UNESCO list of achievements.
For many years he served the famous "Vienna Men's Choir" (Vienna men'sSinging Society:Wiener-Männergesang-Verein) as its president and he wasalso vice-president to the "Society of Friends of Music" in Vienna(Gesellschaft der Musikfreunde). When the historical Music Hall (Musikvere-ins-Gebäude) was opened on the 5th of January 1870, a day of great cele-bration for the whole of Vienna, it was he who announced the completion ofthe building to the emperor and asked him to sign the formal protocol.
On July 25th 1890, the mayor Dr J. Prix declared Dumba "an honorary cit-izen of Vienna" and his name was inscribed in the "Golden Book" of the city.
Following his death the city also honored him with his monument in an hon-orary section of the cemetery (musiker, section 32A, No 25), along with thegreat musicians Beethoven, Schubert, Mozart and Johann Strauss and nextto his close friend Johannes Brahms. The street outside the famousMusikvereins-Gebäude also took his name soon after his death, called"Dumba-stra_e". Without his advice and his dynamic presence we wouldn'ttoday have been able to admire the grand buildings of MusikvereinsGebäude, the Austrian Parliament, the University, the Rathaus, theVotivkirche, the Academy of Arts (Kuenstlerhaus) and many others. Thestatues of the musicians and the artists that decorate the streets and theparks of Vienna were primarily the outcome of his personal initiatives incooperation with other distinct personalities of his era.
It is worth mentioning that, at an extraordinarty meeting soon after his death, held by the mayor of Vienna and with the participation of most of theInstitutions at the time, it was unanimously decided for a statue of NikolausDumba to be erected in the city. A decision which, unfortunately, did notmaterialise - perhaps because the driving force, the person who could carryout such decisions, was not there anymore …he was no longer alive. Never-theless, appreciating how well Vienna knows to honor its citizens, those whohave glorified their beloved city worldwide, there is always a possibility thatthis unanimous decision may yet be carried out. It is an unpaid tribute.
Nikolaus Dumba never forgot his duty to the country of origin of his parents,Greece, which he strongly supported in many ways while it was struggling for survival. This was facilitatedby his influential position as a dis-tinguished member of the thenpowerful Parliament of Vienna .
He was then, unlike today, verywell known to the Greek people.
According to his contemporaryprofessor in the University ofAthens, Theagenis Libadas, theCretans, appreciating his out-standing capabilities, had secretlyoffered him the role of Governor oftheir island when it was fighting for independence. In 1872, in The world concert Hall in Vienna. It was materialized Athens, he was made an honorary by the famous Danish architect Theophil Hansen but member of the local Music and was inspired by Nicolaus Dumba.
Dramatic Society and in 1891 hon- orary president of the Athens Philarmonic Society. The name of NikolausDumba and his father Sterio are both inscribed on a plaque bearing thenames of the benefactors of the University of Athens, in the main entry,under the colourful frescos "Zooforos" which was also their donation. Together with his father Sterio Dumba and other members of their rich andgifted wider family, they led thestrong Greek community in Viennafor decades. After his death on23.3.1900, the international pressfrom the "Manchester Guardian" inEngland to the newspaper "Inde-pendent" in Buffalo of the UnitedStates, presented him as «one ofthe most distinct personalities ofthe 19th century», most of them National Cemetery of Vienna (Musicians section).
underlying his Greek origin, of The city of Vienna honored Nicolaus Dumba byincluding his grave with his monument (1st right) which he was very proud. Today, together with those of the great classical musicians his portrait and those of other Beethoven, Motzart, Schubert, Strauss and Brahms members of his family, dominate in in the National Cemetery. the reception hall in the GreekOrthodox church of Agia Triada in Vienna, as the least recognition andreminder of their generous contributions.
The illustrated biography of Nikolaus Dumba, by J. Tzafettas and E. Konec-ny, is available in the bookshop ‘IANOS' in Thessaloniki.
John M.Tzafettas, MD, FRCOG Professor in Obstetrics and Gynaecology Aristotle University of Thessaloniki-Greece AGOROGIANNI-TSAMI IOANNAP026, P029
ALEVRAS - KOKKALI SOFIA P026, P028,
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MANTOUVALOU M.P008, P057, P058, P064
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VERGOULAS G. P072, P073, P074, PO99
SAMIR A. AMMAR
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Treating Prolonged Grief DisorderA Randomized Clinical Trial Richard A. Bryant, PhD; Lucy Kenny, PhD; Amy Joscelyne, PhD; Natasha Rawson, MPsychol;Fiona Maccallum, PhD; Catherine Cahill, MPsychol; Sally Hopwood, MPsychol;Idan Aderka, PhD; Angela Nickerson, PhD IMPORTANCE Prolonged grief disorder (PGD) is a potentially disabling condition that affectsapproximately 10% of bereaved people. Grief-focused cognitive behavior therapy (CBT) hasbeen shown to be effective in treating PGD. Although treatments for PGD have focused onexposure therapy, much debate remains about whether exposure therapy is optimal for PGD.