Athanasios Sakadamis

Bone Mineral Density and Muscle Strength in Young Men with Mental Retardation (With and Without Down Syndrome)

Abstract. The objective of this study was to compare the bone mineral density (BMD) of men with Down syndrome (DS) to otherwise mentally retarded (MR) men and to investigate whether leg muscle strength of these patients is related to BMD. Two groups with MR (with and without DS) participated in the study, having met the following criteria: similar age, moderate to mild mental retardation, Tanner stage V of sexual development, similar age of beginning to walk, and equal motor activities. The DS group consisted of 8 men 23.9 ± 4.2 years, and the MR group without DS consisted of 8 men 23.5 ± 3.6 years. The two groups were compared with 10 sedentary students of the same age range (25.9 ± 2.9 years) attending our University. The BMD of the 2nd to 4th lumbar vertebrae was measured in the PA projection and the mean density was expressed as g/cm2. The isokinetic muscle strength of the right quadriceps femoris and hamstrings muscles was measured on a Cybex II isokinetic dynamometer. The value measured was peak torque at angular velocities at 60, 120, and 300°.sec−1. The results showed that BMD in DS individuals versus young adults (reference group of the scanner) was lower at the 26% level (T-score − 2.66 ± 0.29) and significantly lower (P= 0.002) than that of the MR group. Significantly different muscle strength was observed between the DS and non-DS MR group (in quadriceps at 300°.s−1: P < 0.01, at 120 and 60°.s−1: P < 0.05; in hamstrings at 300°.s−1: P < 0.05). Higher differences in muscle strength were found between MR and control men, but no significant difference existed in BMD between them. Bivariate correlation showed that quadriceps strength significantly predicted the BMD in the DS patients. Active lifestyle and increased physical exercise to improve muscular strength should be instituted to avoid the development of osteoporosis in DS patients.

Bone mineral density in adults with Down's syndrome.

Abstract. The objective of the study was to elucidate if individuals with Downs syndrome (DS) are likely to experience an increased risk of osteoporosis with advancing age, in addition to precocious aging and their skeletal anomalies. Bone mineral density (BMD) was measured in 22 home-reared adults (9 males and 13 females; age 26.22 ± 4.45 and 23.65 ± 3.23 years, respectively) by dual energy X-ray absorptiometry (DXA). The BMD of the second to fourth lumbar vertebrae was measured in posteroanterior projection and the mean density expressed as grams per square centimetre. The BMD of DS individuals was compared with 27 control subjects (12 males and 15 females) of the same age (age 24.16 ± 3.46 and 23.86 ± 2.92 years, respectively). The results showed that the BMD of the lumbar spine in the males as well as in the females with DS was significantly lower than that in their control counterparts (p < 0.001). Comparing the DS males with the females, the BMD was lower in the males at a level of 9 %. Factors that contribute to this disorder may be mainly the muscular hypotonia, the sedentary lifestyle and the accompanying diseases which frequently observed in the syndrome. Future studies must be focused on the biochemistry of bone metabolism, the evaluation of gonadal, thyroid and parathyroid function, and the genes of the extra chromosome 21.

Bone mass, gonadal function and biochemical assessment in young men with trisomy 21

OBJECTIVE The objective of the study was to find out whether biochemical and hormonal profile of sexual function and mineral metabolism are related to low bone mass in young men with Down syndrome. STUDY DESIGN Eleven young men with trisomy 21 (mean age 26.45 years) and 12 healthy university students of similar age, participated in the study. The bone mineral density (BMD) of the lumbar vertebrae was measured in posteroanterior (PA) projection. Sexual development was assessed by clinical examination. The levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone and parathormone (PTH) were measured accordingly by radioimmunoassay. Serum calcium (Ca) and phosphate (P) as well as fasting urinary Ca and hydroxyproline (OHP) were also measured. RESULTS BMD in DS patients was significantly lower (P<0.001) compared to their control counterparts. No significant differences were observed in mean concentrations of FSH, testosterone and DHEA-S, while LH and 17-OH progesterone levels were significantly higher in DS compared to control group (P<0.01 and <0.05, respectively). Serum Ca and P and urine Ca/Creat ratio did not differ between groups. OHP/Creat ratio was significantly higher in DS patients. PTH levels were extremely low (1pmol/l) in two patients. CONCLUSIONS The findings of this study show decreased bone mass in subjects with DS. Factors, possibly related to low bone mass, are some degree of hypogonadim, hypotonia, low muscular strength and immobility. The findings suggest further research on the biochemistry and endocrinology of bone metabolism in patients with trisomy 21.

Efficacy and safety of ultrasonically activated shears in thyroid surgery

The purpose of this prospective study is to evaluate the efficacy of ultrasonically activated shears (UAS) in hemostasis as well as its safety in regard to complications in thyroid surgery.

Gonadal function in young women with Down syndrome

Objective: Investigations suggest an increased incidence of gonadal dysfunction in patients with Down syndrome. New features, Alzheimer disease and osteoporosis emerge in these individuals. Therefore, hormonal investigation in persons with Down syndrome is pursued. Methods: Thirteen females with trisomy 21 (23.65±3.23 years old) participated in the study. Ultrasound studies were performed to explore the internal genitals. Blood samples were taken for the determination of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), dehydroepiandrosterone sulfate (DHEA‐S), testosterone (T) and 17‐hydroxyprogesterone (17‐OHP). Results: The patients were at stage V of sexual development. Ultrasonography demonstrated normal uterine and ovarian size and endometrial thickness as well. The ovaries of all patients contained follicles of normal distribution and various sizes. The mean concentrations of FSH, DHEA‐S and E2 were normal. The level of PRL was significantly higher than that of the controls, but within the normal lab range. The levels of LH, T and 17‐OHP were significantly elevated, compared to those of the control group (P<0.05, P<0.01, P<0.001, respectively). Conclusions: Our data produce new information on the gonadal function of Down syndrome women. Specific studies on pituitary‐gonadal and pituitary‐adrenal axis function are needed.

A Solitary Gastric Peutz-Jeghers Type Polyp: Report of a Case

Abstract Peutz-Jeghers type polyps of the stomach are rare and almost always associated with intestinal polyposis and mucocutaneous pigmentation; a condition known as Peutz-Jeghers syndrome. The case presented in this report refers to a woman found to have a large solitary Peutz-Jeghers type polyp of the stomach, with a maximal diameter of 7 cm. Extended investigation did not reveal intestinal polyposis or any other sign of Peutz-Jeghers syndrome. Because of the size of the polyp, a partial gastrectomy was performed. To the best of our knowledge, there are only three other reports in the literature of a solitary Peutz-Jeghers type gastric polyp occurring in the absence of Peutz-Jeghers syndrome. This patient is scheduled to undergo a follow-up examination every 2 years to detect any sign of the development of Peutz-Jeghers syndrome or malignancies commonly associated with it.

Ectopic parathyroid adenoma located inside the hypoglossal nerve

Intraneural parathyroid adenomas are extremely rare, with only 9 cases of intravagal adenomas reported. We report the first case of an ectopic parathyroid adenoma located within the hypoglossal nerve.

Retroperitoneal, mediastinal, and subcutaneous emphysema, complicating colonoscopy and rectal polypectomy.

Complications of flexible endoscopy-though still rare-are increasing in frequency lately as more invasive procedures are routinely performed. Perforation, hemorrhage, coagulation disorders, thrombophlebitis, and splenic rupture have all been reported to complicate colonoscopy and colorectal polypectomies. In this paper, we report on a case of retroperitoneal, mediastinal, and neck surgical emphysema, complicating colonoscopy and rectal polypectomy, presented initially as a change in the voice and facial swelling.

A rare case of malignant triton tumor with pluridirectional differentiation.

An enlarging soft tissue mass was resected from the leg of a young man with neurofibromatosis type 1. Rhabdomyosarcomatous elements admixed with islands of osteoid and chondroid matrix was seen on microscopy. Based on immunohistochemistry, a malignant triton tumor, an uncommon subtype of peripheral nerve sheath tumor with rhabdomyosarcomatous elements, was diagnosed. The important feature of this neoplasm was that it showed pluridirectional differentiation to osteosarcoma and chondrosarcoma. This pathologic finding is rare and seen in only a few cases of all malignant triton tumors.

Penetrating Liver Trauma in Pregnancy

AbstractPenetrating abdominal injury during pregnancy is extremely rare. The case of an 18-year-old primigravid woman at 29 weeks’ gestation is presented who sustained a low-velocity handgun penetrating liver injury. Due to her hemodynamic stability, absence of fetal distress and also absence of radiographic and clinical signs of hollow viscus injury, the patient was conservatively treated and discharged in perfect condition on the 10th day following admission.