Cerebral sinus thrombosis presenting with cluster-like headache.
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Cluster Headache↗
Biomedical subjects
G Georgiadis
Publications and source records attributed to G Georgiadis.
Add-on topiramate in the treatment of refractory partial-onset epilepsy: clinical experience of outpatient epilepsy clinics from 11 general hospitals.
An open, prospective, observational study was performed to assess efficacy and adverse-event profile of topiramate as add-on therapy in epilepsy. Outpatient neurology clinics from 11 general hospitals in Greece participated in the study. In total, 211 patients with treatment resistant partial-onset seizures who met the inclusion criteria, were studied. After baseline evaluation, topiramate was given at a target dose of 200mg/day over a 1-month titration period. In the subsequent maintenance period, the topiramate dose could be varied according to the clinical results. Patients were followed for in total 6 months, with monthly visits and regular physical, neurological and laboratory examinations. Seizure frequencies decreased to 35--40% of baseline values following 3 months of treatment and remained relatively constant thereafter. The average monthly seizure frequency over the 6-month study period was 4.61, compared to 9.21 at baseline. The number of responders (patients with at least 50% reduction in seizure frequency) followed a similar pattern, i.e., increase during the first 3 months levelling off at a final 80--85% response rate. Of those completing the study, 30% had been seizure-free for at least 3 months and 12% for 5 months. Topiramate was well tolerated, no deviations in laboratory values were found. Adverse events appeared to occur less frequently, and antiepileptic effects were more pronounced in this prospective open-label study than in earlier reports from randomised controlled trials. The nature of the patient population and the application of individualised dose optimisation are proposed as contributing factors to explain the favourable results of this study.
Adolescent↗
Myoglobinemia and propofol infusion.
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Adult↗
Relationship between shot put performance and triceps brachii fiber type composition and power production.
It is commonly accepted that shot put performance is mainly determined by the ability of the lower body to produce power. The purpose of the present study was to investigate the relationship between shot put performance and triceps brachii muscle fiber type composition and strength capacity. Thirteen male physical education students were selected to participate in the study based upon their shot put performance after 5 weeks of shot put technique instruction. At the completion of this technique-instruction period, they performed the following tests: shot put with a 6-kg shot, isokinetic torque measurements of the elbow extensors at 0, 0.52, 1.04, 1.57, 2.09, 3.14, and 4.19 rad.s(-1), maximal strength (1 RM) and explosive-throwing bench-press tests, one-arm seated shot put with 1-, 2-, 3-, 4-, 5- and 6-kg shot. Whole-body and dominant upper-arm bioimpedance measurements were used to estimate whole-body and upper-arm muscle mass. Muscle biopsy samples from the long head of the dominant triceps brachii were obtained and analyzed for fiber type composition with ATPase histochemistry. Shot put performance was significantly correlated with type II fiber area ( r=0.70, P<0.01), one-arm seated shot put (range r=0.60 to r=0.79, P<0.05), elbow extensors' isokinetic torque (range r=0.65 to r=0.78, P<0.05), bench-press tests ( r>0.86, P<0.01) and estimated arm muscle cross-sectional area ( r=0.68, P<0.05). These results suggest that fiber type composition and the functional capacity of triceps brachii muscle (e.g., isokinetic torque) explain a part of shot put performance. The magnitude of the correlation coefficients between shot put and the upper-body power tests suggests that other body parts (e.g., lower extremities) may play a significant role in this event.
Adult↗
Fulminant Mycoplasma pneumoniae infection with multi-organ involvement: a case report.
A 50-year-old man with no medical history was admitted because of progressive respiratory distress, aseptic meningitis, disseminated intravascular coagulation, cholestatic hepatitis, and renal failure. Mycoplasma pneumoniae infection was confirmed serologically. The patient was treated with erythromycin and showed a favorable recovery. Although M. pneumoniae infection is usually a benign, self-limited acute respiratory disease, on rare occasions it can manifest itself with a fulminant course and multi-organ involvement, even in normal healthy individuals.
Journal Article↗
Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer.
AIM: The peritoneal cancer index (PCI) has been used for the detailed evaluation of the peritoneal spread in tumors of gastrointestinal origin and has been found to be a prognostic indicator of survival. The aim of this study was the identification of the significance of the peritoneal cancer index in advanced ovarian cancer. METHODS: From 1990 to 2001, 60 women, mean age 65+/-10.84 (41-86), were treated for advanced ovarian cancer. The performance status (Karnofsky performance scale), age, prior surgery score (PSS), peritoneal cancer index (PCI), tumor volume, tumor grade, residual tumor, the presence of ascites, treatment with adjuvant chemotherapy, histopathologic subtype and FIGO stage were retrospectively correlated to survival using univariate model of statistical analysis. RESULTS: Hospital mortality and morbidity were 11.7 and 16.7% respectively. The recurrence rate was 23.3%. Overall 5-year survival rate was 41% and mean survival 63+/-8 months. The peritoneal cancer index was related to survival (P=0.0253). The other favorable clinical prognostic indicators of survival were low grade and small volume tumors, treatment with adjuvant chemotherapy and complete cytoreductive surgery (P<0.05). CONCLUSIONS: The peritoneal spread in advanced ovarian cancer can be assessed in detail using the peritoneal cancer index. It is a significant prognostic factor of survival and is useful in identifying subgroups.
Adult↗
Presumed localized tetanus in two cats.
In this report two cases of localised tetanus in two young (<1 year) intact male and outdoor DSH cats, which had been missing, are described. Clinical examination revealed severe muscular spasms on the right (case 1) or both thoracic limbs (case 2). In the latter cat, wrinkling of the forehead and mild trismus were also seen. The routine diagnostic workup (CBC, survey radiographs of the spine, CSF analysis) did not reveal any abnormalities in both cats. EMG testing on the affected muscles in the second animal showed persistent spontaneous motor unit potentials, strongly indicating tetanus. The treatment, that was symptomatic (diazepam, metronidazole) and supportive (physical therapy, assist feeding and intravenous fluid therapy) resulted in the progressive improvement of limb rigidity and the restoration of motor dysfunction in a period of 5- (case 1) and 2- (case 2) month duration.
Animals↗
Post-operative pancreatitis after propofol administration.
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Acute Disease↗
Group B streptococcal prosthetic joint infections.
We report 6 cases of group B streptococcal prosthetic joint infections seen in our institution and review 8 previously reported cases. These 14 patients (6 men and 8 women) had an average age of 69. Seven hip joints and 7 knee joints were affected. Only 4 patients had risk factors for prosthetic joint infection (diabetes mellitus in 2, cancer in 1, and myelodysplasia in 1). The average time from surgery to onset of symptoms was approximately 4 years (range, 5 months to 10 years). Pain in the affected joint was the chief complaint. Six patients had bacteremia. Seven patients had known or suspected foci of infection, which were genitourinary tract (1), skin and soft tissue trauma sites (1), gastrointestinal tract (1), and oropharynx (1). Nine patients required prosthesis removal in addition to antibiotic therapy. Two patients had apparent cure of the infection with retention of the prosthesis. Group B streptococcal prosthetic joint infections appear to be a late complication of prosthetic joint replacement surgery.
Aged↗
Masticatory and skeletal muscle myositis in canine leishmaniasis (Leishmania infantum).
Twenty-four dogs with a parasitologically and serologically established diagnosis of leishmaniasis were studied to investigate the atrophy of the masticatory muscles which commonly occurs in this disease, and to compare the lesions in the masticatory muscles with those in the cranial tibial muscles. The 24 animals were divided into three groups of eight, group A dogs with no muscular atrophy, group B dogs with different degrees of atrophy in the masticatory and skeletal muscles, and group C dogs with similar degrees of atrophy in the masticatory and skeletal muscles. Increased activities of creatine phosphokinase and lactate dehydrogenase were recorded in only some of the dogs in groups B and C, but there were no significant differences between the mean activities in the three groups. Electromyographic changes indicating myopathy and involving both the temporalis and cranial tibial muscles, were observed in two of the dogs in group A, seven of those in group B, and in all the dogs in group C. Muscle histopathology revealed a variable degree of muscle fibre necrosis and atrophy, mononuclear infiltrates and neutrophilic vasculitis in all the dogs except two in group A. Leishmanial amastigotes were found within macrophages and myofibres in 16 of the dogs, some in each group. IgG immune complexes were detected in muscle samples, and circulating antibodies against myofibres were detected in serum samples from all the 24 dogs.
Animals↗
Linear and nonlinear analysis of pressure and flow during mechanical ventilation.
OBJECTIVE: Linear modeling as a method of exploring respiratory mechanics during mechanical ventilation, was compared to nonlinear modeling for flow dependence of resistance in three distinct groups of patients, those with: (a) normal respiratory function (NRF), (b) chronic obstructive pulmonary disease (COPD), or (c) adult respiratory distress syndrome (ARDS). DESIGN AND PATIENTS: Airways opening pressure (Pao), flow (V'), and volume (V) signals were recorded in 32 ICU mechanically ventilated patients, under sedation and muscle relaxation (10 NRF, 11 COPD, 11 ARDS). All patients were ventilated with controlled mandatory ventilation mode at three levels of end-expiratory pressure (PEEPe): 0, 5, and 10 hPa. Data were analyzed according to: (a) Pao = PE + Ers V + Rrs V' and (b) Pao = PE + Ers V + k1V' + k2¿V'¿V'; where Ers and Rrs represent the intubated respiratory system (RS) elastance and resistance, k1 and k2 the linear and the nonlinear RS resistive coefficients, and PE the end-expiratory pressure. The model's goodness of fit to the data was evaluated by the root mean square difference of predicted minus measured Pao values. RESULTS: NRF data fit both models well at all PEEPe levels. ARDS and particularly COPD data fit the nonlinear model better. Values of k2 were often negative in COPD and ARDS groups, and they increased in parallel with PEEPe. A gradual increase in PEEPe resulted in better fit of ARDS and COPD data to both models. CONCLUSIONS: The model of V' dependence of resistance is more suitable for the ARDS and particularly the COPD groups. PEEP tends to diminish the V' dependence of respiratory resistance during the respiratory cycle, particularly in the COPD group, probably through an indirect effect of the increased lung volume.
Female↗
Abnormality of N30 somatosensory evoked potentials in Parkinson's disease: a multidisciplinary approach.
PURPOSE OF THE STUDY: Assess the N30 component of median nerve somatosensory evoked potentials (SEPs) in patients with Parkinson's disease (PD) and correlate its parameters with the severity of the disease, general cognitive ability and regional cerebral blood flow (rCBF). PATIENTS AND METHODS: Twenty-three non-demented, non-depressed PD patients (at stage II and III of the disease) and 23 age- and education-matched normal controls were enrolled in the study. SEPs were elicited by median nerve stimulation. PD patients' cognitive ability was assessed by means of: 1) Raven's Colored Progressive Matrices (RCPM); 2) the Test of Non-Verbal Intelligence (TONI-2); and 3) the Wisconsin Card Sorting Test (WCST). The patients' rCBF was evaluated by HMPAO SPECT. RESULTS: There was no difference between SEP N30 latency in PD patients and controls (P > 0.05). The P20-N30 peak-to-peak amplitude was lower in PD patients bilaterally (P < 0.05), and the amplitude of N30-P40 was lower on the right side only (P < 0.05). A significant increase in the amplitude ratio P14-N20/P20-N30 was observed in PD patients (P < 0.05). The correlation of these findings with the clinical parameters of the disease, and notably motor signs, was not significant. Of the three neuropsychological tests only the RCPM showed a positive relation to right P20-N30 amplitude. Regression analysis between SEP parameters and rCBF showed a correlation of N30 amplitude with blood flow in parietal cortical areas, but not in frontal regions.
Aged↗
ARDS due to Yersinia enterocolitica sepsis in a patient with thalassemia major.
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Adult↗
Bacterial sepsis-induced rhabdomyolysis.
OBJECTIVE: To describe the syndrome of rhabdomyolysis during bacterial sepsis with regard to incidence, blood bacteriology and complications and to examine the association between hyperosmolal state and rhabdomyolysis, evaluating the relationship between plasma osmolality (Posm) and serum creatine phosphokinase (CPK) levels. DESIGN: Prospective study including all patients admitted to the intensive care unit (ICU) for sepsis with positive blood culture and rhabdomyolysis over a 3-year period. SETTING: Seven-bed medical/surgical ICU of a teaching hospital. PATIENTS: 35 patients (group 1) with bacterial sepsis-induced rhabdomyolysis (15 males, 20 females; mean age 71+/-13 years) and 122 (group 2) bacteraemic septic patients without rhabdomyolysis (49 males, 73 females; mean age 68+/-15) were studied. Patients with rhabdomyolysis were divided into gram(+) and gram(-) subgroups according to the blood culture growth. RESULTS: From 491 patients recorded, 35 fulfilled the inclusion criteria for bacterial sepsis-induced rhabdomyolysis (7.1%). Gram-positive bacteria predominated in group 1 (69%), while gram-negative predominated (60%) in group 2. There was a correlation between CPK and Posm levels in the rhabdomyolysis Group (r = 0.52, R2 = 0.27, p = 0.003). There was a stronger correlation between these two variables (r = 0.67, R2 = 0.45, p = 0.001) in the gram(+).subgroup. Acute renal failure (68.5%) and electrolyte disorders such as hyperkalaemia (34%) and hypocalcaemia (48.5%) were the major complications in the rhabdomyolysis group. Sixteen (45.7%) patients in group 1 and 49 (40%) in group 2 died during their stay in the ICU from sepsis and multiple organ failure. Rhabdomyolysis was not considered a contributing factor to their death, as none of our patients died during or immediately after the syndrome. CONCLUSION: Bacterial sepsis-induced rhabdomyolysis results from certain types of microorganisms, mainly gram-positive and to a lesser extent gram-negative. Hyperosmolality is a predisposing mechanism for rhabdomyolysis during bacteraemic sepsis from any type of bacterial microorganism.
Acute Kidney Injury↗
Protein C in the treatment of coagulopathy in meningococcal sepsis.
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Anticoagulants↗
A phase I clinical trial of dextromethorphan in intractable partial epilepsy.
We conducted an open-label pilot study of dextromethorphan (DM) in intractable partial epilepsy with the following objectives: a preliminary evaluation of the drug's safety and efficacy in the epileptic patient and a definition of a concentration range which can be safely achieved in future studies. Sixteen patients with drug-resistant, localization-related epilepsies entered the trial. After an 8-week baseline period, DM was added to the existing antiepileptic drugs at a dose of 40 and 50 mg every 6 h (160 and 200 mg/day). Each treatment period lasted 8 weeks. Seizure control improved after administration of DM, especially in the group of intermediate and slow metabolizers. Two patients, however, experienced increased seizure frequency and withdrew from the study. Adverse effects during DM administration were mild and transient. DM was well tolerated even in patients with high plasma levels of the drug (up to 15020 ng/dl). Our results indicate that DM is safe and effective in the treatment of comedicated patients with intractable partial epilepsies.
Adult↗
The quantitative anatomy of the superior gluteal artery and its location.
Twenty cadaveric posterior gluteal regions were dissected to quantitatively determine the location and dimensions of the superior gluteal artery and its branches on the posterior gluteal region. Two reference lines were defined: one (transverse) was drawn from the posterior inferior iliac spine (PIIS) across the ilium to the anterior superior iliac spine (ASIS), and another (vertical) was drawn orthogonal to the transverse line at a point 8 cm from the PIIS. Results showed that the average distances from the posterior superior iliac spine (PSIS) and PIIS to the superior gluteal artery origin at the sciatic notch were 60 mm and 42 mm, respectively. The deep superior branch traveled an average of 18 mm above the transverse line at the vertical line, and averaged 54 mm from the iliac crest at the same point. This same branch inserted in the medius an average of 29 mm from the ASIS, and 11 mm above the transverse line, while providing 4 to 7 perforators to the gluteus medius and 0 to 2 to the gluteus minimus. The deep inferior branch traveled an average of 23 mm below the transverse line along the vertical line and penetrated the minimus or medius 36 mm from the ASIS, while providing 3 to 8 perforators to the medius and 1 to 3 to the minimus. The average distance from the deep inferior branch to the superior edge of the acetabulum along the vertical line was 25 mm. These data may be helpful in preventing the injury of the superior gluteal artery during the posterior gluteal approach.
Arteries↗