The concurrence of microalbuminuria and retinopathy with cardiovascular risk factors; reliable predictors of asymptomatic coronary artery disease in type 2 diabetes

People with diabetes mellitus type 2 (DM2) have a greater risk for premature morbidity and mortality due to cardiovascular disease than the general population: cardiovascular disease accounts for 75% of deaths in this population group. We examined whether or not the association of clinical cardiovascular risk factors (RF) with both microalbuminuria (MA) and diabetic retinopathy (DR) constitutes reliable evidence for the existence of asymptomatic coronary artery disease (CAD), as assessed by positive myocardial thallium scintiscan using the SPECT method (Tl-scan) in patients with DM2. The study included 76 individuals with DM2 (54 men and 22 women, aged 46-70 years), with a negative history for infarction and negative clinical or ECG findings of CAD. In all patients, 3 overnight (11 pm - 7 am) urine collections were made for evaluation of MA. Fundoscopy after dilatation and a Tl-scan (reference method) were also carried out. In addition, blood pressure and waist/hip ratio were measured and smoking habits were recorded. In the 35 patients with a positive Tl-scan (46%) a higher (p<0.001) incidence of MA, DR, hypertension, smoking and higher waist/hip ratio were detected. Of the 16 patients with concurrent presence of MA and DR, 15 had a positive Tl-scan (94%), whereas the Tl-scan was negative in 30/36 (83%) patients with absence of both MA and DR. One or no cardiovascular RF in the absence of MA and DR increased the prediction of a negative Tl-scan to 100% (NPV: 1.00). Based only on history, fundoscopy and MA testing, and without resorting to expensive and laborious testing procedures, it is possible to safely distinguish patients with type 2 diabetes, who require no further investigations for asymptomatic CAD.     

Subcutaneous dirofilariasis caused by Dirofilaria repens in Greece: a case report

Dirofilaria repens (formerly Dirofilaria conjunctiva ) is a natural parasite of the subcutaneous tissues of dogs, cats and wild carnivores in Europe, Africa and Asia. Microfilariae are transmitted to humans by various species of mosquito. An autochthonous case of subcutaneous dirofilariasis is reported in a Greek patient from the island of Corfu. The clinical manifestation of the infection was a palpable, painless, subcutaneous nodule in the region of the groin, which 2 days before the patient consulted the doctor developed symptoms and signs of inflammation (pain, edema and redness). The entire lesion was surgically removed, and the nematode worm D. repens was identified on histological sections of biopsy material. The aim of this report was (a) to describe the microscopic morphological features of D. repens that enable identification of the parasite on histological examination and (b) to emphasize the importance of consideration of subcutaneous dirofilariasis in the differential diagnosis of subcutaneous nodules with inflammatory eosinophilic infiltration in countries where the infection is endemic.     

Primary lymphoma of the spermatic cord: a case report and review of the literature

Primary lymphomas of the spermatic cord are extremely rare. To date, only 15 cases have been reported in the international literature. Herein, we report a new case of a primary lymphoma of the spermatic cord. A 73-year-old patient presented at the Urology Department, complaining of bilateral painful masses at the inguino-scrotal region. A computed tomography scan revealed spermatic cord tumor. A right inguinal orchidectomy was performed in order to establish a definitive diagnosis. Macroscopically, the tumor was restricted to the spermatic cord area, leaving unaffected the testis and the epididymis. The histopathological and immune-histological evaluation has indicated a diffuse large B-cell lymphoma. Postoperatively, the patient was investigated thoroughly but no further signs of the disease were found.     

Perioperative anti-infective prophylaxis with teicoplanin compared to cephalosporins in orthopaedic and vascular surgery involving prosthetic material

A meta-analysis of randomised controlled trials evaluated the effectiveness and safety of teicoplanin compared to first- or second-generation cephalosporins for perioperative anti-infective prophylaxis in orthopaedic and vascular surgery involving prosthetic material. No differences were found between teicoplanin and cephalosporins with respect to the development of infection at the site of surgery or in remote areas of the body. In addition, there were no significant differences in reported adverse effects or mortality. These findings indicate that both regimens are equally effective in preventing post-operative infections in orthopaedic and vascular surgery involving prosthetic materials.