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Biomedical subjects

N Tzanakis

Publications and source records attributed to N Tzanakis.

32 records · Page 2Linked to original sources
PubMed1998

Gastroesophageal reflux presented with haemoptysis and carinal erythematous lesion resembling in situ carcinoma.

Gastroesophageal reflux (GER) is often associated with respiratory disorders. We report an unusual case of GER presented with haemoptysis. On fibreoptic bronchoscopy (FFB) a focal erythematous lesion of the mucosa of the main carina was found. Repeated FFB and biopsy excluded in situ neoplasm. Pharmacological treatment of GER with sisapride and ranitidine resulted in complete remission of the bronchial lesions. To the best of our knowledge haemoptysis with bronchoscopic lesions due to the gastroesophageal reflux has not been described previously.

Anti-Ulcer Agents↗
PubMed1998

Small airways function in patients with inflammatory bowel disease.

It has been reported that in patients with inflammatory bowel disease (IBD), the airways are involved, and a number of clinical manifestations have been described. The aim of this study was to investigate the function of the small airways in IBD. Thirty patients with IBD (mean age, 47 yr), 12 with Crohn's disease and 18 with ulcerative colitis, were studied and compared with a control group of 16 normal subjects. Maximal expiratory flow-volume curves were performed breathing room air and a mixture of 80% helium, 20% oxygen. The differences of flows at 50% of FVC (delta Vmax50) and the volume of equal flows (Visov) were calculated as indices of small airways function. In addition, spirometry, lung volumes, and diffusing capacity were measured. Visov was statistically significantly greater in patients with either CD or UC than in control subjects (x +/- SD) (24.99 +/- 1.35 and 25.95 +/- 1.5 versus 20.1 +/- 1.39), (p < 0.01 and p < 0.001, respectively). A reduction in TL(CO) was noticed in the active stage of the disease in both groups of patients (p < 0.05). This may indicate that lung parenchyma is also involved in active IBD. Our results suggest that the function of the small airways and diffusion capacity of the lungs are affected in patients with IBD.

Adult↗
PubMed1998

Diagnosis and treatment of chronic obstructive pulmonary disease: evidence-based medicine.

Chronic obstructive pulmonary disease (COPD) is a very common disorder caused primarily by cigarette smoking. Recently national and international guidelines were produced in order to standardize the management of the disease. It became apparent that only a few items in these documents are based on evidence-based studies. Diagnosis should be made in relation to the definitions, symptoms, signs and routine investigation. Spirometry is essential for the diagnosis of COPD. The two well documented modes of treatment, namely cessation of smoking and long-term oxygen therapy are discussed in detail.

Diagnosis, Differential↗
PubMed1998

Long-term oxygen therapy on the island of Crete, Greece.

The aim of this study was to investigate the extent of use, the selection criteria for usage and the conditions under which long-term oxygen therapy (LTOT) is provided on the island of Crete, Greece. A total of 545 patients using oxygen therapy at home in Crete were found from the records held by local hospitals, health insurance offices and oxygen supply companies. After randomization, 100 patients were selected, and finally 79 patients (64 males, 15 females), with a mean age of 71 yrs, were contacted and completed a questionnaire. The majority of patients (n = 57, 72%) using LTOT had a diagnosis of chronic obstructive pulmonary disease (COPD). In 67 (85%) patients LTOT was prescribed by a chest physician. All patients used large oxygen cylinders. The duration of daily oxygen use was significantly longer in the group of patients prescribed it by chest physicians than in those who was prescribed it by doctors from other specialities (8.8 h versus 4.7 h, p < 0.05). Of the patients, 47 (60%) fulfilled the criteria for LTOT. However, only 33 (43%) had accurate written instructions on how to use their home oxygen. A significant number of patients (n = 24, 29%) were still smokers and 63 (80%) had had a follow-up assessment. Our results suggest that COPD is the major grounds for LTOT. The daily duration of the oxygen therapy was longer in the group prescribed it by chest physicians. It is a concern that difficulties in setting up oxygen cylinders resulted in some ineffective usage. Physicians should stress the advantages of O2 concentrators.

Age Distribution↗
PubMed1997

Effectiveness of Tc-99m sestamibi compared to Ga-67 in patients with pulmonary sarcoidosis.

The authors evaluated the suitability of Tc-99m MIBI to be used as an alternative to Ga-67 in pulmonary sarcoidosis imaging. Studies were performed on 21 patients. Eleven patients (group I) had been on corticosteroid treatment before the study, while 10 patients (group II) had received no treatment. Activity of sarcoidosis was assessed from clinical manifestations of the disease, pulmonary function tests, bronchoalveolar lavage, high-resolution computed tomography, and serum biochemistry. Ga-67 imaging results were abnormal in 73% of patients of group I (n = 8) and 90% of patients of group II (n = 9). Tc-99m MIBI imaging results were abnormal in 0% of patients of group I (n = 0) and 40% of patients of group II (n = 4). The lymph nodes were better demonstrated with Ga-67. Abnormal results of Ga-67 imaging were 100% sensitive to clinically active sarcoidosis, but had a relatively low specificity (33%). In contrast, abnormal MIBI imaging had very low sensitivity (11%). The authors conclude that planar Tc-99m MIBI scintigraphic images are not sensitive for the diagnosis of pulmonary sarcoidosis.

Adult↗
PubMed1996

Effects of laparoscopic cholecystectomy on global respiratory muscle strength.

Laparoscopic cholecystectomy has a better postoperative outcome than the traditional open technique, which has been shown to significantly affect respiratory muscle function. The aim of this study was to investigate the effects of laparoscopic surgery on respiratory function, and particularly that of the respiratory muscles. Respiratory muscle strength was assessed in 26 patients who underwent laparoscopic cholecystectomy and in 25 who underwent open cholecystectomy by measuring mouth pressure during maximum static inspiratory (PImax) and expiratory (PEmax) efforts. PImax, PEmax, and blood gases were measured 24 h preoperatively (-24 h) as well as 24 h (+24 h) and 48 h (+48 h) postoperatively. FEV1 and FVC were measured at -24 h and +48 hr, and the ratio of FEV1 to FVC (FEV1/FVC) was calculated. PImax decreased at +24 h and +48 h in both groups, but this decrease was significantly greater in the patients who had open surgery, (p < 0.01, and p < 0.005, respectively). Similarly, PEmax was significantly smaller in the open- than in the laparoscopic-surgery group (p < 0.0001) at +48 h. Spirometric indices showed a more severe restrictive defect at +48 h after open surgery than after laparoscopy (p = 0.01). The arterial oxygen tension (PaO2) was significantly greater in the laparoscopic- than in the open-surgery group at +24 h (p < 0.007). Laparoscopic cholecystectomy caused smaller decreases in respiratory muscle strength than did open surgery. This accords with the hypothesis of phrenic nerve inhibition during open surgery. The results are of clinical importance, since they may explain the different outcomes with the two techniques.

Adult↗
PubMed1996

Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema.

Intrapleural urokinase has not been evaluated systemically in terms of efficacy, safety, and cost of treatment in a large series of patients with complicated (parapneumonic) pleural effusions (CPE) and pleural empyemas (PE). Furthermore, the optimal dose and duration of treatment is not known. Twenty consecutive patients with multiloculated parapneumonic effusions (13 with CPE and 7 with PE), in whom a single chest tube failed to drain the fluid, were studied prospectively. The age of the patients ranged 15-92 yrs (median 51 yrs). Urokinase was administered intrapleurally, in a low single daily dose of 50,000 U in 100 mL normal saline via the chest tube. Previous intrapleural instillation of 100 mL normal saline failed to promote drainage in all patients. Urokinase enhanced drainage in all patients. Clinical and radiological improvement was noted in all but one patient. The mean (SD) volume of fluid significantly increased in the first 24 h post-urokinase (p<0.001). The number of urokinase instillations ranged 3-7 (median 5). Radiological evaluation showed excellent improvement in 13 of the 20 (65%) patients. Urokinase was well-tolerated in all patients. The clinical course of patients was uneventful at a mean follow-up of 15 months (range 6-30 months) later. Mean total cost of treatment was $530 +/- 34.6. Our results show that intrapleural instillation of small doses of urokinase is a cost-effective and safe mode of treatment of complicated pleural effusions and pleural empyema and could be the fibrinolytic of choice.

Adolescent↗
PubMed1995

Probability and characteristics of human immunodeficiency virus infection in male Greek military personnel with tuberculosis.

The probability of an AIDS patient being infected with tuberculosis (TB) has been studied in different populations and found to be increased by as much as 500 times, but the reverse, i.e. the probability of a patient with TB being infected with HIV, has not been studied. The aim of this study was to investigate the hypothesis of greater HIV seropositivity and altered immune status, as indicated by CD4+ T-lymphocyte counts, in TB patients. We prospectively studied 162 males, aged 18-30 years, hospitalized for active, proven TB. Serum for HIV antibodies was tested twice by ELISA and confirmed by the Western blot technique. The control group consisted of 145,000 blood donor volunteers serving in the army, aged 18-30 years. The number of CD4+ T lymphocytes was also measured in the patients and the control group. We found that the rate of HIV seropositivity in TB patients was 2.4% (4 of 162), while it was 0.214% in the control group (p < 0.0001). Using the Bayes' theorem we found that the probability of a TB patient being infected with HIV was 9.1%, approximately 150 times higher than the expected rate in the matched control group (p < 0.0001). The number of CD4+ T lymphocytes was significantly lower in pulmonary and extrapulmonary TB patients than in the control group, taking into account the HIV status (p < 0.001). Our results suggest that there is a 150 times greater probability of a TB patient being infected with HIV. CD4+ T lymphocytes are significantly lower in all groups of TB patients.

AIDS-Related Opportunistic Infections↗
PubMed1995

Respiratory muscle strength during continuous ambulatory peritoneal dialysis (CAPD).

The purpose of this study was to investigate the effect of chronic renal failure (CRF) and continuous ambulatory peritoneal dialysis (CAPD) on respiratory muscle function. Global respiratory muscle strength was assessed by measuring mouth pressures during maximum static inspiration (PIMAX) near residual volume (RV) and expiration (PEMAX) near total lung capacity (TLC), in 26 patients. Maximum pressures, spirometry and lung volumes were measured before dialysis, 4 h after the administration of 2 l of dialysate into the peritoneal cavity, and just after the next drainage. In addition, biochemical indices (urea, creatinine, sodium, potassium, calcium and phosphorus) and haematological indices (haemoglobin (Hb) and haematocrit (Hct)) were measured once before the treatment. The results showed that mean PIMAX and PEMAX were normal, with a very wide range between patients, before CAPD. However, seven patients (27%) showed a PIMAX of < 75% predicted (pred) and eight (31%) a PEMAX < 75% pred. Maximal pressures decreased significantly during CAPD and increased again after the drainage of fluid. Similarly, lung volumes were within the normal range before and decreased significantly during CAPD. The forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio did not change. We conclude that respiratory muscle strength was preserved in the majority of the patients with chronic renal failure treated with CAPD. During CAPD, lung volumes and respiratory muscle function were decreased, demonstrating an effect of the abdominal cavity on the mechanics of the respiratory system. However, the decrease in the maximum pressures was less than 20%, indicating that CAPD is a safe procedure in patients without pre-existing pulmonary disease or uraemic pulmonary complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1993

Effect of aminophylline on respiratory muscle strength after upper abdominal surgery: a double blind study.

BACKGROUND: The effect of aminophylline on maximum respiratory muscle strength in patients undergoing upper abdominal surgery was investigated. METHODS: An open pilot study was performed in which aminophylline was administered continuously for 48 hours after surgery (protocol I). In a second group of subjects aminophylline was given for 24 hours after cholecystectomy in a double blind placebo controlled trial (protocol II). Twelve patients participated in the pilot study (group A) and 25 in protocol II of which 14 received aminophylline (group B) and 11 placebo (control, group C). Respiratory muscle strength was assessed by measuring mouth pressures during maximum static inspiratory and expiratory efforts. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), vital capacity (VC), inspiratory maximum pressures (PImax), expiratory maximum pressures (PEmax) were measured 24 hours preoperatively, PImax and serum theophylline 24 hours postoperatively, and FEV1, FVC, VC, PImax, PEmax, and serum theophylline 48 hours after surgery. RESULTS: FEV1, FVC, and VC decreased in all groups of patients at +48 hours. PImax fell at +24 hours and +48 hours but this decrease was significantly smaller in the two groups who received aminophylline than in the control group. PEmax showed a decrease at +48 hours but this reduction was similar in all three groups studied, independent of the treatment given. These data suggest that either aminophylline had a protective effect only on the inspiratory muscles or, most probably, that the effect of aminophylline was central, reducing the phrenic nerve inhibition induced by cholecystectomy and thus improving diaphragmatic function. CONCLUSIONS: Upper abdominal surgery decreases inspiratory and expiratory muscle strength and aminophylline has a protective effect only on inspiratory muscle function. This may have important clinical applications in minimising pulmonary complications after cholecystectomy.

Abdomen↗
PubMed1992

The role of inexperience in measuring tuberculin skin reaction (Mantoux test) by the pen or palpation technique.

We have shown previously that experienced readers can use the palpation or pen method for reading the Mantoux tuberculin skin test with accuracy. In order to investigate if the inexperienced reader can use both methods with the same degree of accuracy, we performed Mantoux tests in 539 healthy subjects, aged 20-57 years (mean 33 years), using the PPD-RT 23 in dose 2 I.U. (1/5000). In random order and a double-blind fashion, an experienced and an inexperienced reader measured the induration after 48 h by the palpation method initially and then by the pen method, without knowing the identity of the subject. Results of the study did not show any significant difference in any range of measurements by the two readers, using either the pen or palpation method (P greater than 0.1). A highly statistically significant linear relationship was found between the measurements by the pen method used by experienced and inexperienced readers (r = 0.823, P less than 0.0001) and between the palpation measurements by the two readers (r = 0.939, P less than 0.0001). We conclude that the effects of an inexperienced examiner in the measurement of of tuberculin skin induration are minimal. Inexperienced readers can use the pen method as accurately as the traditional palpation method.

Adult↗
PubMed1992

Respiratory muscle strength in hyperthyroidism before and after treatment.

We undertook this study to investigate respiratory muscle strength in relation to thyroid function in 20 thyrotoxic patients and in a group of 20 normal subjects matched for age and sex. Global respiratory muscle strength was assessed by measuring mouth pressure during maximal static inspiratory (PImax) and expiratory (PEmax) efforts. We also measured VC, FVC, and FEV1 as well as thyroid-related hormones (T3, T4, TSH). Measurements were made once in normal subjects and twice in thyrotoxic patients, before and 3 months after medical treatment. Our results showed that both maximal pressures were significantly reduced (p less than 0.0001) before treatment in thyrotoxic patients in relation to the mean values of the normal subjects (p less than 0.0001), and they increased significantly (p less than 0.0003) after treatment. Lung volumes were significantly reduced (p less than 0.0001) before and increased significantly (p less than 0.008) after treatment. The ratio FEV1/FVC did not change. A statistically significant linear relationship was found when PImax of patients with thyrotoxicosis before treatment and of normal subjects were plotted against thyroid hormones (T3, T4) (r = -0.746 and r = -0.745, respectively, p less than 0.001). Similarly, a statistically significant linear relationship was found between PEmax and T3 and T4 (r = -0.837 and r = -0.838, respectively, p less than 0.001). No relationship was found between maximal pressures and TSH. Finally, a significant linear relationship was found between PImax and PEmax (r = 0.872, p less than 0.001). Our results confirm that in thyrotoxicosis respiratory muscle weakness occurs that affects both inspiratory and expiratory muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Respiratory muscle strength in hypothyroidism.

To investigate respiratory muscle strength in patients with hypothyroidism, global respiratory muscle strength was assessed by measuring mouth pressure during PImax and PEmax efforts. Maximum pressures, VC, FEV1, FVC, T3, T4, and TSH were measured in 43 hypothyroid patients. Measurements were made before and three months after replacement therapy with thyroxine. The results showed that the mean value of PImax and PEmax increased after treatment. Significant change was found in the mean value of VC, FEV1, and FVC after treatment but not in the FEV1/FVC ratio. A highly statistically significant linear relationship was found between PImax and TSH and between PEmax and TSH as well as between PImax and T3 and PEmax and T3. We conclude that hypothyroidism affects respiratory muscle strength and that this weakness is linearly related to thyroid hormone levels. Respiratory muscle weakness is present in both inspiratory and expiratory muscles and is reversible with treatment.

Adult↗