Successful intravenous regional sympathetic blockade (Bier's Block) with guanethidine and lidocaine in a patient with advanced Buerger's Disease (thromboangiitis obliterans)--a case report

A 65-year-old man, a heavy smoker with Buerger's disease (thromboangiitis obliterans), presented to this department with persistent severe ischemic rest pain at the fingers of his right hand, not responding to oral treatment with vasodilators and analgesics. Critical blood flow was discovered in the middle, ring, and little finger, with ischemic ulcerations apparent in the fingertips of these 3 fingers. The distal phalanx of the little finger had been amputated 6 months before because of gangrenous necrosis. In an attempt to avoid further disabling amputations, the patient received 3 series of Bier's block sessions with guanethidine and lidocaine according to a specific protocol. Marked increase in finger blood flow was induced even after the first series, and complete disappearance of both fingertip ulcerations and ischemic rest pain was achieved. No side effects were observed. The above-described method in a patient with advanced Buerger's disease resulted in excellent pain relief and full restoration of both blood flow and function of the affected fingers.     

Translation and validation of the Depression Outcomes Module (DOM) in Greece

In Greece, as in other countries, major depressive disorder is underdiagnosed. Its severity, implications and outcomes are often not adequately evaluated. The Depression Outcomes Module (DOM) was developed in order to meet the need for a global assessment of this disorder. The objective of the current study was to estimate the psychometric properties of DOM in a Greek population presenting depressive symptoms. The DOM was translated into Greek. Patients were examined twice (baseline and follow-up assessment). The psychometric properties of DOM were calculated. Subjects were 83 psychiatric inpatients and outpatients presenting depressive symptoms. The measures used were DOM, Structured Clinical Interview for DSM III-R (SCID) and Hamilton Rating Scale for Depression (Ham-D). The results were: (a) baseline assessment: test-retest reliability k = 0.90, internal consistency 0.93, sensitivity 97%, specificity 90%; (b) follow up assessment: test-retest reliability k = 0.89, sensitivity 81% and specificity 67%. Recovery from depression detected by DOM at the follow-up was significantly correlated both with pharmacotherapy and with a combination of pharmacotherapy and supportive psychotherapy. It was concluded that the Greek version of DOM is a comprehensive, useful instrument for diagnosing, assessing depression and evaluating its outcomes.     

Low bacterial count urinary tract infections in infants and young children

The purpose of the study was to compare bacterial species, clinical, laboratory and imaging findings (^99m Tc-dimercaptosuccinic acid renal scan and voiding cystogram) in infants and children with high (10⁵ colony forming units (CFU)/ml, group A patients) and low (5×10⁴ CFU/ml, group C patients) bacterial count in urine cultures during first episode of urinary tract infection. Group B included patients with intermediate CFU/ml. Included were 419 symptomatic patients with: (a) no previous antibiotic treatment, (b) urine samples for quantitative cultures taken by bladder catheterisation or suprapubic bladder aspiration, (c) growth of only one microorganism, and (d) age 54 months (age of the oldest patient of group C). Out of 419 cultures, Escherichia coli grew in 315 (75.2%), gram-negative bacteria except E. coli in 91 (21.7%) and gram-positive in 13 (3.1%). Group C patients were significantly ( P <0.0001) more often affected with gram-negative pathogens except E. coli than group A patients (21/44 versus 67/360). Most of group C patients were younger than 24 months of age; none was older than 54 months. Comparison of the prevalence of clinical and laboratory (leucocyte count, CRP, ESR) findings between groups A and C showed no significant differences. There was no statistically significant difference in the prevalence of pyelonephritis, reflux and urological malformations (except reflux) between groups A and C. Conclusion: Low bacterial count urinary tract infections mainly affect infants and young children and are often due to gram-negative bacteria other than E. coli. Clinical and laboratory findings, prevalence of pyelonephritis, reflux and urological malformations are similar in high and low bacterial count urinary tract infections.     

Clinical features and natural history of physical urticaria in children.

Physical triggers are the most common precipitating factors for chronic urticaria in childhood. We investigate the natural history of physical urticaria (PU) and attempt to identify prognostic features. A retrospective study covering a 3 yr period (1999-2002) identified 82 children with PU seen in a tertiary referral centre. Parents of 53 children with PU responded to follow up by questionnaire and were included in the data analysis. The questionnaire ascertained symptom severity, remission status, effects of treatment and prognostic factors in determining resolution of the urticaria. Not all parents answered every question. Fisher's exact test was used to compare the remission and non-remission groups and Kaplan-Meir survival analysis was used to derive estimates of time to achieve remission. All 53 children with PU had chronic urticaria, with dermatographic, cholinergic and mixed subtypes of PU forming over 70% of the subtypes. Overall, 13% (6/45) of the children reported respiratory symptoms with the episodes of urticaria, and 67% (35/52) reported associated angioedema. In univariate analysis, a history of other allergic conditions in the child was associated with a greater chance of non-remission (p = 0.007). No significant difference in the age of onset of urticaria and duration of individual bouts was noted between the remission and non-remission groups. Episodes of urticaria were significantly less frequent (p = 0.02) in the remission group (monthly/weekly/daily - 70%/30%/0%) than the non-remission group (38%/34%/28%). Among the 20 children achieving remission, on average this occurred 30 months after onset of symptoms. In the survival analysis, the number of children becoming urticaria free was 11.6% (95% CI: 5.4%-23.9%) at 1 yr post-onset and 38.4% (95% CI: 25.9%-54.3%) 5 yr post-onset. In conclusion, based on this selected tertiary population, the prognosis for PU may not be as benign as has previously been reported. A history of allergic conditions and more frequent episodes of urticaria were associated with a poorer prognosis.     

The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis

Background  

Ultrasonography of temporal arteries is not commonly used in the approach of patients with suspected giant cell arteritis (GCA) in clinical practice. A meta-analysis of primary studies available through April 2004 concluded that ultrasonography could indeed be helpful in diagnosing GCA. We specifically re-examined the diagnostic value of the ultrasonography-derived halo sign, a dark hypoechoic circumferential thickening around the artery lumen, indicating vasculitic wall edema, in GCA.     

Angiolymphoid hyperplasia with eosinophilia: good response to photodynamic therapy

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign vascular disease of unknown pathogenesis, that occurs as solitary or multiple nodules or papules. Lesions are located mainly on the head, forehead and neck, and may be persistent and difficult to eradicate. We report a case of ALHE treated with aminolaevulinic acid photodynamic therapy (ALA‐PDT). Treatment consisted of two ALA‐PDT sessions with a 2‐week interval. Clinical evaluation, 8 weeks after treatment, showed marked improvement though not complete regression. The treatment was well tolerated. At follow‐up 4 months after treatment, the lesions were stable. We believe that PDT could be an alternative therapeutic approach for ALHE or could be used as a neoadjuvant treatment to reduce lesion size especially where size or site of lesions limits the efficacy or acceptability of other treatments. The lack of cumulative effects allows repeated treatments with ALA‐PDT, but long‐term follow‐up is advised for assessment of recurrence.     

Association of demographic, clinical and treatment variables with quality of life of patients with epilepsy in Greece

PURPOSE: The aim was to study the influence of patients' age, frequency and type of seizures, disease duration, number of AEDs and use of benzodiazepines on the quality of life of patients with epilepsy. PATIENTS AND METHODS: We consecutively identified 223 patients with epilepsy who attended the epilepsy outpatient clinics at three university hospitals in Greece. Quality of life was evaluated by QOLIE-31. One-way analysis was used to assess the association of the studied factors and QOLIE-31 subscales. After checking for co-linearity, we performed multivariate stepwise linear regression analysis with all the variables that on univariate analysis showed a statistically significant effect on each subscale of QOLIE-31 to explore which of the studied factors affect independently on QOLIE-31 scores. RESULTS: Of a total of 223 patients, 118 (52.95%) were men; mean age was 35.18 +/- 13.22; mean duration of the disease was 13 years; 58 (26%) patients had generalized seizures, 93 (41.7%) had PS, and 72 (32.3%) of the patients had PsG; 85 (38.1%) were on polytherapy and 38 (17%) were taking benzodiazepines. Independent factors affecting QoL were: seizure frequency (Overall QoL P = 0.0001, Seizure worry and Emotional well-being P < 0.0001, Energy/fatigue and Social functioning P = 0.01); duration of the disease (Overall QoL and Energy/fatigue P = 0.01, Seizure worry P = 0.008, Cognitive functioning P < 0.0001); polytherapy only for the Emotional well-being P < 0.0001; and use of benzodiazepines (Overall QoL, Energy/fatigue, Social functioning P = 0.002, Cognitive functioning P < 0.0001). CONCLUSION: Our findings suggest that QoL in epileptic patients might be affected, in addition to the other established factors (high frequency of seizures and polytherapy), by the daily use of benzodiazepines as adjunctive therapy. Change of medical strategy concerning this medication may lead to improving the QoL of these patients.