Dimitrios Anyfantakis

Rectus sheath hematoma: A review of the literature

Rectus sheath hematoma (RSH) is a relatively rare clinical condition, strongly associated among others, with abdominal trauma and anticoagulation. Although well documented over the years, it still seems to be often misdiagnosed. Estimations of further increase in incidence are made, based on the increasing use of anticoagulants. Thus it was of interest to us to perform a literature review on the available literature of this entity with the aim to facilitate a better understanding and management in primary and secondary care settings. This review intends to present a synthesis on the main topics of this condition such as pathophysiology, epidemiology, predisposing factors, clinical presentation, diagnosis and basic treatment instructions. The initial search resulted in 146 articles. Additional citations from the reference list of the relevant publication were also included. Every physician in the field of primary/emergency medicine and surgery must be familiar with it, as misdiagnosis may lead to unnecessary laparotomy or death. In contrast, faster and more accurate diagnosis can lead to mortality rate reduction and cost containment.

Massive gastrointestinal bleeding due to isolated jejunal varices in a patient without portal hypertension

INTRODUCTION Isolated ectopic varices located in the small bowel are uncommon. Portal hypertension caused by liver cirrhosis is the most common predisposing risk factor. PRESENTATION OF CASE We present an unusual case of massive gastrointestinal bleeding from idiopathic jejunal varices in a 73-year-old Caucasian male without portal hypertension. Exploratory laparotomy disclosed ectopic varices located in the small intestine. Segmental resection of the jejunum with end to end anastomosis resulted in a complete resolution of the haemorrhage. During a 5 year follow up, the patient is stable with no bleeding recurrence. DISCUSSION Information on aetiology, diagnosis and management of jejunal varices is reviewed. CONCLUSION Diagnosis and management of isolated jejunal varices is challenging. Surgeons as well as acute care physicians have to consider idiopatic form of jejunal varices as a potential cause of gastrointestinal bleeding when gastroduodenoscopy and colonoscopy are negative.

Impact of religiosity/spirituality on biological and preclinical markers related to cardiovascular disease. Results from the SPILI III study

AbstractOBJECTIVEThis study aimed at exploring to what extent psychosocial factors, such as religiosity/spirituality and sense of coherence, mediate the negative effects of stress on a variety of cardiometabolic indicators, i.e., hypertension, diabetes, cardiovascular and cerebrovascular disease, and atherosclerotic bio-clinical markers.DESIGNA total of 220 subjects (66.2±16.0 years) of the SPILI III cohort (1988–2012) attending a primary care setting in Spili, a rural town in crete, represented the target group for the present study. Of these, 195 (88.6%) participated in the re-examination (67.2±15.2 years). All participants underwent a standardized procedure including evaluation of anthropometric measurements, biochemical indicators of atherosclerosis, stress hormones, in parallel with ultrasound measurements of carotid intima media thickness (IMT). Religiosity, spirituality and sense of coherence were evaluated with the use of international questionnaires translated into the Greek language and linguistically validated. RESULTSParticipants with higher levels of religious and spiritual beliefs presented lower levels of carotid IMT (1.01±0.101 vs 1.53±0.502 mm, p<0.001). Patterns of inverse relationships were also observed between religiosity/spirituality and prevalence of diabetes (35.1% vs. 2%, p<0.001) with an estimated diabetes risk, fully adjusted odds ratio, 95% CI: 0.91 (0.87–0.94). Highly religious participants presented lower serum cortisol levels (12.3±5.8 vs. 18.2±5.1 µg/dl, p<0.001). Sense of coherence was positively associated with religiosity/spirituality [mean SOC (SD): 123±20 vs. 158±15) p<0.001]. CONCLUSIONSThese findings may be associated with a possible favourable effect of religiosity/spirituality on several cardio-metabolic determinants, therefore deserving further attention by healthcare practitioners and researchers.

A fatal case of seronegative, late-onset systemic lupus erythematosus presenting with motor sensory axonal polyneuropathy

Systemic lupus erythematosus is a multisystemic, autoimmune, inflammatory disorder predominantly affecting young females. Its onset may be abrupt or insidious, presenting with a broad range of clinical and immunological features. We report an unusual case of elderly-onset systemic lupus erythematosus in a woman initially diagnosed with discoid lupus, and subsequently admitted to hospital due to a progressive psycho-motor deficit. Electrophysiological measurements suggested a diagnosis of acute motor sensory axonal neuropathy. Unusual clinical features and negative serology led to diagnostic uncertainty. This case report offers information on the course of the disease through the entire chain of the health care delivery (from primary to tertiary). Despite the efforts of the hospital staff, it was not possible to save the life of the woman.

Colorectal cancer, screening and primary care: A mini literature review

Colorectal cancer (CRC) is a common health problem, representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality, with annual deaths estimated at 700000. The western way of life, that is being rapidly adopted in many regions of the world, is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore, the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians (PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein, we review the main topics of CRC in the current literature, in order to better understand its pathogenesis, risk and protective factors, as well as screening techniques. Furthermore, we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.

Hepatopulmonary hydatidosis in a ten-year-old girl: a case report.

IntroductionHydatid disease is a parasitic infection caused by the tapeworm Echinococcus granulosus and is characterised by cystic lesions in the liver and lungs. Concomitant pulmonary and hepatic localization of hydatid cysts in childhood is unusual and represents a distinct clinical entity called hepatopulmonary hydatidosis.Case presentationA ten-year-old Caucasian girl, a permanent resident of rural Greece, was admitted to hospital reporting a nonspecific symptomatology compatible with a diagnosis of viral infection. Chest radiography revealed a large homogenous circular opacity in the right lung field. On the basis of imaging studies, a diagnosis of hydatidosis was made with synchronous hepatic and pulmonary involvement, successfully managed through a single-stage transthoracic surgical approach.ConclusionThis case report highlights the necessity of realizing that hydatid disease continues to be a public health problem, which often remains asymptomatic for years. Therefore, the presence of any homogeneous cystic spherical opacity on routine chest radiography should raise the suspicion of hydatid disease, mainly in endemic areas such as Greece. General practitioners and physicians involved in pediatric care need to be familiar with the diagnosis and management of the variable clinical manifestations of hydatid disease. Taking into consideration that hepatopulmonary hydatidosis represents a special entity that requires a different therapeutic approach may positively affect its economic and social-related burden.

Glossopharyngeal neuralgia associated with cardiac syncope: Two case reports and literature review

Highlights • Glossopharyngeal neuralgia is a rare craniofacial syndrome sometimes associated by syncope.• A synthesis on topics such as pathogenesis, diagnosis and management is presented.• A high levels of awareness for diagnosis and management is required from surgeons.

Selective mutism due to a dog bite trauma in a 4-year-old girl: a case report

IntroductionA child experiencing an event of threatening or catastrophic nature may experience considerable post-traumatic psychological distress. Dog bites present an important public health problem and are a frequent cause of physical trauma in children. Physicians who manage paediatric trauma may not be vigilant of the high risk of psychological stress in children exposed to a physical injury.Case presentationA 4-year-old white girl of Greek origin, with a dog-bite related trauma was admitted to the University Hospital of Crete, Greece, for surgical repair and intravenous antibiotic therapy due to extensive lesions. Exposure to the traumatic event triggered the onset of an unusual psychological response, selective mutism and acute post-traumatic stress disorder.ConclusionThere is limited literature discussing the psychological effect of dog bites in children. Parents and physicians involved in pediatric physical trauma need to be more familiar with post-traumatic behavioral reactions. Awareness of the potential development of such reactions may result in early detection and effective management of children at risk.

Postpartum Spontaneous Subcapsular Hepatic Hematoma Related to Preeclampsia

Subcapsular hematoma of the liver represents an unusual clinical phenomenon in the pregnancy and postpartum period with serious complications in terms of fetal and maternal mortality. Here we report a case of a 32-year-old primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. The woman underwent an emergency caesarean section with the extraction of an alive foetus. A few hours after delivery, she was transferred to the emergency department of our institution complaining of severe epigastric pain. Diagnostic work-up was suggestive of a subcapsular right lob hepatic hematoma which was successfully managed conservatively. Timely diagnosis is necessary for the prevention of life-threatening events in mother and fetus. For this reason acute care physicians have to be vigilant of the condition and consider this in the differential diagnosis of epigastric pain during pregnancy and postpartum.

Severe throat pain in patients with negative oropharyngeal examination: four case reports and overview of the literature.

ABSTRACT Throat pain is one of the most frequent complaints prompting patient visits to healthcare professionals. Primary care physicians being the fi rst contact point are frequently encountered with symptoms such as sore throat and odynophagia. However, high level of diagnostic uncertainty exists when the oropharyngeal examination is normal despite patients’ complaints of severe pain. We present four Caucasian Greek patients, two males aged 47 and 57 years and two females aged 32 and 47 years respectively admitted to an Ear Nose and Throat department of a general hospital, with severe throat pain and initially normal oropharyngeal examination. This case series highlights the necessity for a high level of suspicion on the part of the primary care physicians when facing patients complaining of severe throat pain since their symptoms may indicate conditions such as supraglottitis, lingual tonsillitis or pemphigus vulgaris. A careful clinical examination, including an indirect laryngoscopy, is required especially when the initial oropharyngeal examination is normal. РЕЗЮМЕ Боль в горле, из-за чего пациенты обращаются к врачу, представляет собой самую частую жалобу. Общепрактикующие врачи очень часто встречаются с пациентами, жалующимися на воспаление горла и боль при глотании. Однако существует высо- кая диагностическая неуверенность в случаях, когда осмотр орофаринкса не показывает ничего анормального, несмотря на жалобы пациента на сильную боль. В настоящей работе авторы описывают четыре случая греческих пациентов (2 мужчины в возрасте соответственно 47 и 57 лет и 2 женщины в возрасте соответственно 32 года и 47 лет), поступивших в оториноларингологическое отделение с жалобами на сильную боль в горле (при первоначальном осмотре горла - нормальные находки). Эта серия пациентов подчеркивает необходимость в пристальном внимании со стороны общепракти- кующих врачей в случаях, когда налицо сильная боль в горле, так как симптомы могут указывать на заболевания как супраглотит, лингвальный тонзиллит или пемфигус вулгарис. Необходим очень внимательный осмотр, включающий непрямую ларингоскопию, особенно когда осмотр орофаринкса окажется отри- цательным.