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51.
Advances in biological sciences and medicine have revolutionized current practice and opened new horizons. Tissue and organ transplantation is a miracle and an action of love and sacrifice for the sake of fellow human beings. Organ transplantation has been commonplace over the last decade but Greece still remains the lowest numerically among European countries in this field because of the lack of organ donation although it is highest in traffic accidents. Despite this, the legal framework regulating transplantation was enacted late in comparison to other European countries, and was not the only obstacle to the development of organ donation. Several other factors such as philosophy, culture, traditional and religious attitudes, lack of public information and lack of the relevant social fabric, have all contributed to the current sad situation. This article aims to present a critical view on the evolution of the legal framework in the field of tissue and organ transplantation in Greece. Issues that still deter organ donation are discussed along with an insight into the current situation in the Greek social context in order to make a constructive contribution to future perspectives. 相似文献
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Giannoukas AD Tsetis D Kostas T Petinarakis I Ioannou C Touloupakis E Katsamouris AN 《World journal of surgery》2003,27(5):554-557
Abstract
The objective of this study was to review our diagnostic approach using color duplex scanning (CDS) in the management of symptomatic
outpatients with suspected lower limb deep venous thrombosis (DVT). CDS was carried out in 315 consecutive outpatients with
unilateral symptoms consistent with DVT. Both limbs were assessed in 205 patients. Other pathology was routinely sought when
the symptomatic limb was free of thrombosis. Acute DVT was present in 25% (76/315) of the symptomatic limbs, and in only 8%
it was confined to calf veins. Other pathology was detected in 90 limbs (28%). Swelling with or without pain was associated
with DVT in 44% and 10%, respectively. The time elapsed between the onset of symptoms and CDS was 3 days (range 1–6 days).
DVT in the contralateral asymptomatic limb was present in 5 (9%) of the 56 patients with DVT in the symptomatic limb. In the
absence of DVT in the symptomatic limb, the contralateral asymptomatic limb was free of thrombosis. Clinical diagnosis of
DVT in outpatients was unreliable. CDS revealed that only one-fourth of the symptomatic limbs had DVT, and other pathology
mimicking DVT was present in 28%. CDS is a useful tool that offers a prompt, efficient diagnosis. Investigation of the contralateral
asymptomatic limb seems to be necessary only when DVT is found in the symptomatic limb.
Electronic Publication 相似文献
53.
Y. El Wajeh A.D. Giannoukas C.J. Gulliford S.K. Suvarna P. Chan 《European journal of vascular and endovascular surgery》2004,28(6):590-594
BACKGROUND: Recurrence of varicose veins after apparently adequate surgery is common. Neovascularisation, the formation of new vascular channels between a venous surgery site and new varicosities, is thought to be an important cause of recurrence. The aim of this study was to provide histological evidence of the 'neovascularisation'process. METHOD: Tissue samples from the region of the previously ligated saphenofemoral junction (SFJ) were taken from 14 limbs with recurrent varicose veins and from nine control limbs. Tissue samples were analysed histologically for overall vascularity, and the presence of intimal circular fibrosis, intimal eccentric fibrosis, medial thickened elastosis, and thrombosis in the microscopic thin walled vessels within the tissue. The same samples were analysed immunohistoligically for S100, a neural marker, and Ki-67 (Mib 1), a marker of endothelial proliferation. Absent S100 and positive Ki-67 were considered as evidence of new vessels. RESULT: No significant difference was found between the venous recurrence and control groups in respect to histological features. S100 positive nerve fibrils were seen associated with dilated venous channels in the majority of both redo and control groups (p=1, Fisher's exact test). Only one section stained positively with Ki-67 (Mib1) in a single vascular channel for a few endothelial cells. The remaining control and redo cases were negative for Mib 1 (p=1, Fisher's exact test). CONCLUSION: We found little evidence of neovascularisation associated with recurrent varicose veins in the saphenofemoral region. The venous channels that develop at the previously ligated SFJ may represent adaptive dilatation of pre-existing venous channels (vascular remodelling), probably in response to abnormal haemodynamic forces. 相似文献
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N Labropoulos S S Kang M A Mansour A D Giannoukas V Moutzouros W H Baker 《European journal of vascular and endovascular surgery》2002,23(4):344-348
OBJECTIVE: this prospective study was designed to evaluate the evolution of thrombus propagation and lysis in relation to patterns and distribution of isolated calf DVT. METHODS: fifty-two limbs in 48 patients mean age 59+/-15, range 24-78 years, with isolated calf DVT that had at least one exam within 10 days of DVT detection were included in the study. Patients with a documented episode of prior DVT or evidence of post-thrombotic changes during the initial ultrasound exam were excluded. The initial thrombus length, patterns and location of the thrombi were recorded. On follow-up the propagation and lysis patterns of the clot were studied. RESULTS: remodelling of the thrombus, excluding echotexture and vein diameter changes on ultrasound, occurred in 23 limbs, (44%). Ascending propagation only was seen in seven limbs (13%) descending propagation only in two (4%) and in both directions in five (10%). Propagation at least to popliteal vein was detected in seven limbs (13%). Thrombus developed or extended to initially uninvolved veins in six limbs (12%). Pulmonary embolism developed only in one patient (2%; 95% CI: 0-11%). The site and the size of thrombus or the number of veins involved in the baseline exam did not correlate with the remodeling of thrombus. Soleal and gastrocnemial veins were comparable with the posterior tibial and peroneal veins in terms of thrombus propagation and lysis. CONCLUSIONS: early thrombus remodelling occurs in 44% of limbs with isolated calf DVT. This includes ascending and descending thrombus propagation and lysis. Thrombus development or propagation to initially uninvolved calf veins is found in 12%. Thrombus remodelling does not appear to be related to size, site and patterns of thrombosis. 相似文献
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Athanasios D. Giannoukas Georgios Baltoyiannis Manolis Milonakis Dimitrios Nastos Lambros Papagikos Angelos M. Kappas Michalis Fatouros Constantinos Papadimitriou Diamantis Cassioumis 《World journal of surgery》1996,20(4):501-506
p
= 0.474 and
p
= 0.62, respectively). Misoprostol alone also did not offer significant protection to the gastric or the duodenal mucosa (
p
= 0.08 and
p
= 0.65, respectively). The combination of HSV plus misoprostol protected the gastric mucosa (group V,
p
= 0.007) but not the duodenal mucosa (group V,
p
= 0.08). Hence HSV or misoprostol alone offers no protection to the GDM from the effects of DS. The combination of HSV and
misoprostol offers significant protection only to gastric mucosa. Enhancement of the mucosal defense mechanisms combined with
strong reduction of gastric acidity may offer adequate protection to gastric mucosa from the effects of nonsteroidal antiinflammatory
drugs. 相似文献
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