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S A Raptis

Publications and source records attributed to S A Raptis.

At least 73 records · Page 4Linked to original sources
PubMed1997

Omeprazole induces a long-term clinical remission of protein-losing gastropathy of Ménétrier's disease.

We report a patient with Ménétrier's disease presenting with extensive subcutaneous oedema, ascites and pleural effusion due to hypoalbuminaemia. Gastric secretory studies showed no free basal and stimulated acid secretion. The gastric juice contained significant amounts of albumin (0.2 g/dl) and immunoglobulin G (IgG) (1.11 mg/dl), corresponding to an estimated daily loss of 9.7 g and 45 mg, respectively. Protein-losing gastropathy was initially unsuccessfully treated with famotidine (80 mg/day) for 17 months, but a long-term (25 months) clinical remission was subsequently achieved with omeprazole (20 mg/day). We suggest that excellent clinical remission of Ménétrier's disease and the associated protein-losing gastropathy may be obtained with long-term omeprazole maintenance treatment, possibly due to Helicobacter pylori suppression.

Aged↗
PubMed1997

Efficacy of deoxycholate amphotericin B and unilamellar liposomal amphotericin B in prophylaxis of experimental Aspergillus fumigatus endocarditis.

OBJECTIVE: To evaluate and compare in vivo the protective efficacy of unilamellar liposomal amphotericin B (L-AmB) with that of deoxycholate amphotericin B (D-AmB) in experimental endocarditis. MATERIAL AND METHODS: In the rabbit model of experimental Aspergillus fumigatus endocarditis, two doses of each antifungal agent (1.5 mg/kg each) were administered intravenously at 4 hours and at 30 minutes before challenge with an inoculum of A. fumigatus. Three days later, the animals were sacrificed, and the aortic vegetations were analyzed. RESULTS: All 19 animals that did not receive chemoprophylaxis acquired endocarditis. In contrast, endocarditis developed in 2 of 10 animals pretreated with D-AmB (P < 0.01) and 3 of 8 animals pretreated with L-AmB (P < 0.01). Both D-AmB and L-AmB prevented the development of endocarditis due to A. fumigatus and decreased the concentration of fungi in the aortic vegetations by more than 1 log10. CONCLUSION: In the rabbit experimental model of Aspergillus endocarditis, D-AmB and L-AmB were equally effective in reducing the incidence of the infection and the tissue burden of fungi.

Amphotericin B↗
PubMed1996

Adrenaloma: a call for more aggressive management.

We review our experience from the surgical management of 57 patients (24 males, 33 females) with a mean age of 48.5 years who underwent adrenalectomy because of the computed tomography (CT) finding of a "nonfunctioning" adrenal tumor (adrenaloma). We found that CT consistently underestimated the real histologic size of the adrenal tumor (p = 0.001). Of the 57 resected tumors, 23 were cortical adenomas, 7 myelolipomas, 8 adrenal cysts, 11 nodular hyperplasias, 2 primary adenocarcinomas, 2 metastatic carcinomas, and 4 pheochromocytomas. The mean diameter was 5.89 cm and the mean weight 114.07 g. The mean diameter of the resected primary adenocarcinomas was 3.0 cm and 4.5 cm, respectively. The operative mortality was zero and the perioperative morbidity minimal. The mean operating time was 137 minutes (range 60-240 minutes). The posterior approach had the shortest operating time and the laparoscopic approach the shortest hospital stay and the least postoperative need for narcotics. During the 6.2 years mean follow-up period, five patients with preoperative hypertension remained normotensive, and both patients with the resected primary adenocarcinomas are alive without recurrence. We suggest a more liberal surgical approach to patients with adrenalomas because: (1) even small tumors can be malignant or potentially lethal (e.g., pheochromocytomas); (2) some tumors that appear to be nonfunctioning may in reality be functioning; and (3) other nonfunctioning tumors may, with time (and without prior notice), function. The low risk of adrenalectomy especially via the laparoscopic approach can provide an early definitive diagnosis and treatment, avoiding the cost of repeated CT scans and other studies as suggested by the currently prevailing conservative management of these tumors.

Adenocarcinoma↗
PubMed1996

Therapeutic effect of glibenclamide in a fixed combination with metformin or phenformin in NIDDM patients.

The combination of a sulfonylurea with a biguanide improves the pancreatic beta-cell insulin secretion and the insulin utilization in peripheral tissues in NIDDM. This open, crossover, randomised and prospective study was designed to compare the effects of the fixed combination glibenclamide-metformin (GL-METF)-2.5 and 400 mg respectively, with the fixed combination glibenclamide-phenformin (GL-PHEN)-2.5 and 25 mg respectively, on NIDDM diabetes control. Thirty NIDDM patients, in ideal metabolic control, who were being treated with GL-PHEN were divided in two groups. One group received GL-PHEN for 12 weeks followed by 12 weeks treatment with GL-METF and the reverse treatment was given to the second group. A statistically significant decrease of post-prandial blood glucose (p = 0.034) and glycosylated haemo-globin (p < 0.02) values was observed under GL-METF treatment compared to those with GL-PHEN. The values of lactic acid were within normal limits during both treatments. The insulin secretion after breakfast was similar with both drug compounds. The BMI of the patients remained the same during a follow-up study of 24 weeks. Lipid metabolism did not change significantly during the trial and the safety parameters (renal and liver function, full blood count) remained unchanged. In conclusion, the administration of GL-METF leads to better diabetes control in NIDDM patients compared to that of GL-PHEN.

Aged↗
PubMed1996

The role of diabetic neuropathy and high plantar pressures in the pathogenesis of foot ulceration.

Diabetic foot ulceration is currently a serious medical problem and has, therefore, attracted much research attention during the last two decades. Previous foot ulceration, diabetic neuropathy, limited joint mobility, high plantar pressures, microangiopathy, macroangiopathy and diabetic nephropathy have already been identified as risk factors for future foot ulceration. Neuropathy has clearly been shown to be an essential permissive factor in the development of ulceration in the non-ischaemic foot. Moreover, the pathogenetic role of high plantar pressures is crucial in the presence of established clinical neuropathy. Nowadays, our therapeutic efforts clearly aim to prevent than treat foot ulcers. This demands specialist and team work in the setting up of a diabetic foot clinic in an attempt to identify and educate the diabetic patients at risk and, where possible to use suitable plantar pressure-reducing systems (footwear, hosiery etc.). Then only would it be reasonable to postulate that a significant reduction in amputations of diabetic aetiology could be achieved in the near future.

Diabetic Neuropathies↗
PubMed1996

Helicobacter pylori may induce bile reflux: link between H pylori and bile induced injury to gastric epithelium.

Helicobacter pylori and duodenogastric reflux are both recognised as playing aetiological roles in chronic gastritis. This study investigated whether H pylori colonisation of the antral mucosa and duodenogastric reflux are independent phenomena or have a causal relationship. Thirty eight patients (15 men, 23 women) aged (mean (SD)) 48 (17) years participated. Each patient underwent gastroscopy. Antral biopsy specimens were taken to investigate H pylori colonisation. In addition BrIDA-99mTc/111In-DTPA scintigraphy was used to quantify duodenogastric reflux. H pylori positive patients who were found to have duodenogastric reflux were treated with amoxycillin (1 g/d) and metronidazole (1.5 g/d) for seven days and four tablets of bismuth subcitrate daily for four weeks. Follow up antral biopsies and scintigraphy were repeated at six months. Duodenogastric reflux could not be found in 18 patients, including eight (44%) who were H pylori positive. Ten of the 11 patients who had duodenogastric reflux (reflux % 11.6 (9.2)), however, were H pylori positive (chi 2 = 6.26, p = 0.01). These 10 patients were given eradication treatment. At six months, in six patients who became H pylori negative, duodenogastric reflux was significantly reduced from a pretreatment value of 14.3% to 3.3% (two tail, paired t = 2.57, p = 0.016). These data suggest that H pylori may induced duodenogastric reflux which may be important in the pathogenesis of H pylori gastritis or carcinogenesis, or both.

Adult↗
PubMed1995

Choledochocele, an overlooked diagnosis: report of 15 cases and review of 56 published reports from 1984 to 1992.

BACKGROUND AND STUDY AIMS: Choledochocele (CDCL) is still regarded as being a rare abnormality, despite the increasing number of case reports published in the last ten years. The aim of this prospective study was to investigate the prevalence rate of CDCL in patients referred for endoscopic retrograde cholangiopancreatography (ERCP), as well as the short-term and long-term complications of endoscopic treatment. PATIENTS AND METHODS: Over a seven-year period, fifteen symptomatic patients (ten male, five female, age range 47-93 years) were identified as having CDCL out of a total of 1019 ERCP referrals to our unit. The diagnosis of CDCL was made by both duodenoscopy and ERCP. RESULTS: All 15 patients had small (4-25 mm) CDCLs associated with pancreatic (n = 1) or biliary (n = 14) disorders. Ten of the 15 patients (67%) had choledocholithiasis as well. Twelve patients were treated by endoscopic sphincterotomy (ES), and three by surgery. The immediate post-ES complications (2 of 12, 16.7%) were acute cholangitis (n = 1) and acute pancreatitis (n = 1). Eleven (76%) of the 14 patients who had a complete follow-up were symptom-free, with normal liver function tests at a median of 18 months (range 12-97). Two patients reported episodes of acute cholangitis, and one patient died of a misdiagnosed ampullary carcinoma arising in the CDCL. CONCLUSIONS: These results suggest that CDCL is probably an overlooked diagnosis in patients with pancreaticobiliary symptoms. It should be readily recognized and treated, preferably by endoscopic sphincterotomy. The endoscopist must be aware that an ampullary carcinoma may develop in a CDCL.

Aged↗
PubMed1995

The role of colonoscopy in the differential diagnosis of acute, severe hemorrhagic colitis.

BACKGROUND AND STUDY AIMS: This study assesses the diagnostic value of colonoscopy performed at an early stage of a first attack of acute, severe hemorrhagic colitis. PATIENTS AND METHODS: One hundred fourteen consecutive patients were prospectively studied. The colonoscopic diagnosis was compared with the final diagnosis of the colitis, which was based on clinical, microbiological, endoscopic, and histological criteria during the acute illness, but also on the results of a thirty-month follow-up of the patients aiming to confirm whether the colitis was relapsing or nonrelapsing in nature. RESULTS: The colonoscopic diagnosis was ulcerative colitis (UC) in 40, Crohn's disease in four, and infective colitis (IC) in 70 patients. The endoscopic diagnosis was finally confirmed in all 40 UC patients and in 68 of 70 (97.1%) IC patients. Two patients with an initial endoscopic and histological diagnosis of IC presented with typical attacks of UC 28 and 30 months later, respectively. Prominent endoscopic appearances in IC were mucosal edema, erythematous areas, hemorrhagic spots, bleeding, microaphthoid ulcers, and luminal exudate. Although rectal sparing was occasionally seen, endoscopic lesions were continuous and severe in the distal colon, but were patchily and unevenly distributed in other parts of the colon in IC. In UC, prominent colonoscopic findings were bleeding, mucosal friability, granularity, and ulceration; lesions were continuously distributed in the involved area. CONCLUSIONS: Colonoscopy is a useful procedure in the differential diagnosis of severe bloody diarrhea of unknown cause.

Acute Disease↗
PubMed1995

Honey may have a laxative effect on normal subjects because of incomplete fructose absorption.

Honey contains fructose in excess of glucose, which may lead to incomplete fructose absorption associated with abdominal symptoms and/or diarrhea. This hypothesis was investigated in 20 healthy volunteers (13 males, 7 females) with a mean (+/- SD) age of 35.9 +/- 12.1 y. Each subject drank the following aqueous solutions in random order: 20 g lactulose, 100 g honey, 50 g honey, and 35 g each of a glucose and fructose mixture. The breath-hydrogen concentration was measured every 15 min for 6 h. Semiquantitative estimates of carbohydrate malabsorption were assessed with lactose as a nonabsorbable standard. Breath-hydrogen concentrations increased by 52 +/- 6, 30 +/- 4, 20 +/- 3, and 4 +/- 1 ppm (mean +/- SEM) after each of the four test solutions, respectively. The estimated carbohydrate malabsorption was 10.3 +/- 1.8, 5.9 +/- 1.2, and 0.5 +/- 0.2 g after 100 g honey, 50 g honey, and the glucose-fructose mixture, respectively (F[2,57] = 16.05, P < 0.001). Within 10 h after the ingestion of 100 g honey, 50 g honey, and the glucose-fructose mixture, six, three and none of the volunteers, respectively, reported loose stools (chi 2 = 7.1, df = 2, P < 0.03). The results of this study suggest that carbohydrate malabsorption after ordinary doses of honey is frequent in healthy adults and may be associated with abdominal complaints. Honey may have a laxative effect in certain otherwise healthy individuals, probably because of incomplete fructose absorption.

Absorption↗
PubMed1995

Simultaneous laser Doppler and transcutaneous oxygen tension measurements in claudicant patients.

Laser Doppler (LD) flux and transcutaneous oxygen tension (TcPO2) were measured in supine and sitting position at the dorsum of the foot with local skin temperature of 37 degrees C and 44 degrees C in 50 patients with stage IIb of chronic peripheral arterial occlusive disease (CPAOD) and in 30 healthy controls. The statistical analysis showed no significant differences between patients and controls in the supine and sitting position at 37 degrees C. A lower increase of LD- flux and TcPO2 could be noticed during hyperthermia and reactive hyperaemia in the patients group as well as a significant prolongation of oxygen (ORT) and flux reappearance time, of postocclusion time to peak flux and oxygen peak, of postocclusion time to half of peak flux and oxygen peak and of time to flux restoration at preocclusion levels (FTMAX) during reactive hyperaemia test. FTMAX and ORT allowed a clear separation between patients and controls and exhibited a high reproducibility. A regression analysis equation was derived with the most significant parameters indicating the presence and the severity of the disease. Moreover, the estimated time parameters of LD - flux and TcPO2 were correlated with the US - Doppler ankle systolic blood pressure indices and therefore with the impairment of the macrocirculation. In summary, we find that skin perfusion in patients with intermittent claudication is not different from normal subjects under basal conditions. However, maximal perfusion is reduced and the time to peak perfusion after a provocative stimulus is delayed.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Gas Monitoring, Transcutaneous↗
PubMed1994

Does acromegaly really predispose to an increased prevalence of gastrointestinal tumours?

OBJECTIVE: The few published prospective studies suggest a strong association of colonic tumours with acromegaly, but include small numbers of patients. In addition, the upper gastrointestinal tract of these patients has never been prospectively studied. The aim of the present study was to investigate the incidence of gastric and colonic tumours in a large cohort of acromegalic patients. DESIGN: Acromegalic patients consecutively admitted to an Endocrinology Department for diagnosis and follow-up, were submitted to gastroscopy and colonoscopy, to identify those harbouring gastrointestinal tumours. PATIENTS: Over a 5-year period, 54 out of 61 patients (78% with active disease) received colonoscopy and 42 out of 61 gastroscopy. No patient had a past history of gastrointestinal malignancy. MEASUREMENTS: All polypoid lesions found at colonoscopy and gastroscopy were separately recorded and biopsied. RESULTS: No case of gastrointestinal cancer or gastric polyp was discovered. Nineteen patients (35%) had 1-8 colonic polyps, including 5 (9.3%) with adenomas. When compared to patients with a normal colon, those with polyps were significantly older (44.5 +/- 14.2 vs 52.1 +/- 10.9 years, P = 0.047), but the duration of acromegaly (10.8 +/- 8.4 vs 10.9 +/- 7.1 years, P = 0.9) and the number of patients with active disease were similar in both groups. CONCLUSIONS: Acromegalic patients do not have an increased incidence of gastric tumours. The observed significant variation in the prevalence of colonic adenomas (9-35%, P = 0.03) and cancer (0-15%, P = 0.017), between our patients and those of the published prospective studies with similar demographic characteristics, suggest that environmental and hereditary factors may be more important than the presence of acromegaly.

Acromegaly↗
PubMed1994

Antiphospholipid syndrome: clinical and therapeutic aspects.

The purpose of the present study was to evaluate patients with the antiphospholipid syndrome with particular attention to their initial clinical features, final diagnoses and the course of thrombotic events in association with therapy. The methodology applied was the following: retrospective analysis of 30 patient files (20 female, 10 male) with antiphospholipid syndrome (APS). Four types of therapy were evaluated for their efficacy to prevent thrombotic recurrences, aspirin 100 mg daily plus low-dose prednisone 10-15 mg daily, warfarin (with international normalized ratio 2 to 2.6), immunotherapy alone and no therapy. None of the patients was followed-up during pregnancy. The probability of thrombosis-free survival was estimated according to Kaplan-Meier method, while the statistical significance was tested by the log rank test. There were 21 patients with primary APS and 9 with secondary, 8 of whom had SLE and one patient who had primary Sjögren's syndrome. The age at onset and the disease duration did not differ between men and women, while patients with secondary APS had a longer disease duration than patients with primary APS, a finding indicating that SLE patients develop, for unknown reasons, APS a long time after the initiation of their disease. Twenty patients experienced recurrent thrombotic events (a total of 46 recurrences) of which 43 (93%) were identical to the first event. Thus, in the majority of the cases arterial were followed by arterial and venous by venous thrombotic events: a finding suggesting a tissue-related factor for initiation of thromboses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Therapy of acute pancreatitis with somatostatin.

BACKGROUND: The various conservative measures which have been used to date in the treatment of acute pancreatitis have not proven helpful. However, somatostatin appears to have a favourable effect on the course and outcome of this potentially lethal disease. METHOD AND RESULTS: Experiments in animals have shown that somatostatin prevents experimentally induced acute pancreatitis and lowers the mortality rate of established pancreatitis. In human acute pancreatitis, somatostatin reduces gastric and pancreatic secretions; it reduces the local complication rate and shortens hospitalization. The effect of somatostatin on the mortality rate of acute pancreatitis has not been demonstrated in isolated studies, although a meta-analysis of randomized controlled trials has shown a mortality rate of 6.2% in the somatostatin treated group versus 14.0% in the placebo-treated group. The synthetic analogue of somatostatin, octreotide, is an effective treatment for established local complication of acute pancreatitis, such as pancreatic fistulae and pseudocysts. CONCLUSION: It is suggested that large-scale, carefully designed multi-centre studies of somatostatin are needed if the beneficial effects of this drug on the course and outcome of acute pancreatitis are to be evaluated.

Acute Disease↗