A case of early depressed-type ampullary carcinoma treated by wire-guided endoscopic resection

A 72-year-old man, with known prostate cancer, was admitted to our endoscopic unit for further evaluation of an obstruction at major papilla level. Endoscopic cholangiopancreatography revealed a depressed-type carcinoma at the ampulla of Vater and dilation of both the common bile and pancreatic ducts without intraductal filling defects. Intraductal ultrasonography showed a hypoechoic mass limited to the ampulla of Vater. Endoscopic wire-guided ampullectomy was performed after informed consent was obtained. Histologic examination of the resected specimen showed a completely excised well-differentiated adenocarcinoma limited to the ampulla of Vater. Both accurate preoperative staging and proper histologic evaluation of the resected specimen seem to justify endoscopic treatment of early ampullary cancer by an experienced endoscopist.     

Unsaturated dideoxy fluoro-ketopyranosyl nucleosides as new cytostatic agents: A convenient synthesis of 2,6-dideoxy-3-fluoro-4-keto-β-d-glucopyranosyl analogues of uracil, 5-fluorouracil, thymine, N-benzoyl cytosine and N-benzoyl adenine

The β-protected nucleosides of uracil (2a), 5-fluorouracil (2b), thymine (2c), N⁴-benzoyl cytosine (2d) and N⁶-benzoyl adenine (2e) were synthesized by condensation of the peracetylated 3-deoxy-3-fluoro-d-glucopyranose (1) with the corresponding silylated bases. The nucleosides were deacetylated and several subsequent protection and deprotection steps afforded the partially acetylated analogues 6a–e. Selective iodination followed by hydrogenation gave the acetylated dideoxy analogues of uracil (8a), 5-fluorouracil (8b), thymine (8c), N⁴-benzoyl cytosine (8d) and N⁶-benzoyl adenine (8e), respectively. Finally, direct oxidation of the free hydroxyl group at the 4′-position of 8a–e, and simultaneous elimination reaction of the β-acetoxyl group, afforded the desired unsaturated 2,6-dideoxy-3-fluoro-4-keto-β-d-glucopyranosyl derivatives 9a–e. The new analogues were evaluated for antiviral and cytostatic activity. Compounds 9a–e were not active against a broad panel of DNA and RNA viruses at subtoxic concentrations. However, they were markedly cytostatic against a variety of tumor cell lines. The compounds should be regarded as potential new lead compounds to be further investigated for anticancer therapy.     

Increase in chronic or recurrent rhinitis, rhinoconjunctivitis and eczema among schoolchildren in Greece: Three surveys during 1991–2003

The prevalence of allergic rhinitis, hay fever and eczema has risen worldwide during the last four decades but may have reached a plateau in some westernized societies. We examined time trends in the prevalence of childhood chronic or recurrent rhinitis, rhinoconjunctivitis and eczema in urban Greece. Using identical methodology, three population-based cross-sectional parental questionnaire surveys on current (last two years) and lifetime allergic symptoms of the nose, eyes and skin were performed among 8–10-yr-old children in 1991, 1998 and 2003 in Patras, Greece. Exactly 2417, 3006 and 2725 questionnaires were completed in 1991, 1998 and 2003, respectively. Prevalence rates of current (lifetime) symptoms of chronic or recurrent rhinitis were 5.1% (6.0%) for 1991, 6.5% (8.0%) for 1998 and 8.0% (9.8%) for 2003. Respective values for rhinoconjunctivitis were 1.8% (2.1%), 2.7% (3.4%) and 3.6% (4.6%) and for eczema 2.5% (4.5%), 3.4% (6.3%) and 5.0% (9.5%) (p for trend <0.001). Among current asthmatics there was an increase in lifetime rhinitis (p = 0.038), current (p = 0.025) and lifetime rhinoconjunctivitis (p = 0.007) and current (p = 0.001) and lifetime eczema (p < 0.001); male predominance increased throughout the study. The proportion of atopic asthma (current asthma with chronic or recurrent rhinitis and/or rhinoconjunctivitis and/or eczema) increased during the same period (p < 0.001). In conclusion, there is a continuous increase in the prevalence of allergic manifestations among preadolescent children in Patras, Greece during the period 1991–2003. In our population, boys have contributed to this increase more than girls and the increase of atopy is, at least partially, responsible for the increase of asthma.     

Tobacco smoking, pregnancy estrogens, and birth weight

It has been suggested that tobacco smoking during pregnancy reduces birth weight by lowering production rates or levels of total pregnancy estrogens. To evaluate this hypothesis, we examined total estrogen levels by radioimmunoassay in the blood of 141 pregnant women attending the maternity clinic of a major university hospital in Athens during their 26th week of pregnancy. Forty-nine of these women were regular smokers before and during their pregnancy, whereas the remaining 92 had never been regular smokers and did not smoke at all during their pregnancy. Birth weight of offspring was lower among smokers than among nonsmokers by 190.8 g, with a 90% confidence interval of 41.1 to 340.5 g, and higher among women with higher serum estrogen levels (slope b = 1.2 g per 1000 pg/ml with a 90% CI of 0.2 to 2.2 g). There was, however, only a small negative relation between tobacco smoking and serum estrogen levels; in smokers, total estrogen levels were reduced to 91% of the corresponding levels among nonsmokers.     

A psychoanalytically oriented combined treatment approach for severely disturbed borderline patients: the Athens project

A psychoanalytically oriented combined treatment is considered beneficial for severely disturbed borderline patients, especially during an acute crisis. The proposed treatment comprises hospitalization and specialized psychotherapeutic inpatient treatment, individual psychoanalytic psychotherapy, and psychiatric management. It is important to take into account that during inpatient treatment, projective identifications and splitting mechanisms are activated, involving different members of the therapeutic personnel or other patients. The mental health team--the psychiatrist, the nurses, the assigned psychotherapist, and other members of the therapeutic personnel--should work together in the context of teamwork in order to explore transference and countertransference manifestations. This function promotes empathy and understanding of the patient's inner difficulties. A combined treatment approach can help the patient stabilize his or her condition and develop awareness and motivation for undertaking long-term treatment and individual psychoanalytic psychotherapy, with the prospect that therapy will be maintained after the patient's discharge.     

Adrenal pseudocyst presenting as acute abdomen during pregnancy

Pseudocysts of the adrenal gland are rare lesions, which are usually discovered as incidental findings. Since they are in the majority of cases non-functioning, they become symptomatic only when they are complicated with rupture, haemorrhage or infection. We present a case of a 28-year-old woman in the 26th gestational week, who developed an acute abdomen due to a haemorrhagic pseudocyst of the left adrenal. The patient was submitted to left adrenalectomy. The described case is the third reported case of cystic adrenal lesion discovered during pregnancy and only the first reported case of acute presentation of an adrenal pseudocyst during pregnancy.