K. Charalabopoulos

Penetration of Antimicrobial Agents into the Prostate

In the present review article, the penetration of antimicrobial agents into prostatic fluid and tissue was examined. Three major factors determining the diffusion and concentration of antimicrobial agents in prostatic fluid and tissue are the lipid solubility, dissociation constant (pKa) and protein binding. The normal pH of human prostatic fluid is 6.5–6.7, and it increases in chronic prostatitis, ranging from 7.0 to 8.3. A greater concentration of antimicrobial agents in the prostatic fluid occurs in the presence of a pH gradient across the membrane separating plasma from prostatic fluid. Of the available antimicrobial agents, β-lactam drugs have a low pKa and poor lipid solubility, and thus penetrate poorly into prostatic fluid, expect for some cephalosporins, which achieve greater than or equal to the inhibitory concentration. Good to excellent penetration into prostatic fluid and tissue has been demonstrated with many antimicrobial agents, including tobramycin, netilmicin, tetracyclines, macrolides, quinolones, sulfonamides and nitrofurantoin.

Immunohistochemical study of angiogenesis and proliferative activity in epiretinal membranes

Formation of epiretinal membranes (ERMs) is a serious complication of retinal diseases, the most important being proliferative diabetic retinopathy (PDR) and proliferative vitreoretinopathy (PVR). In this study, our goal was to (i) calculate the microvessel density (MVD), (ii) evaluate vascular endothelial growth factor (VEGF) expression and (iii) correlate angiogenesis with the proliferative activity as expressed by the expression of Ki67 marker, in both membrane types.

Fatal meningitis due to Listeria monocytogenes in elderly patients with underlying malignancy

Adult patients with malignancies are considered to be at a high risk for Listeria monocytogenes meningitis. The Microbiology Laboratorys database of the University Hospital of Ioannina, Greece, was searched for cases of L. monocytogenes during the period from January 1990 to December 2002. Listerial meningitis occurred in three patients: one with brain tumour, one with chronic lymphocytic leukaemia, and one with non‐Hodgkins lymphoma. All the patients were older than 70 and they were actively receiving therapy for their malignancy. L. monocytogenes type 4b was isolated from blood and cerebrospinal fluid. All were treated with ampicillin and gentamicin, but they died shortly after the initiation of the treatment. Experience with the three present cases indicated the high mortality rate due to listerial meningitis in this immunosuppressed population. So, listeriosis should be suspected in patients with meningitis and underlying malignancy. Since meningitis due to L. monocytogenes is not distinguishable clinically from other types of bacterial meningitis, it is recommended to cover Listeria in the initial empirical therapy of bacterial meningitis in immunosuppressed patients.

Giardia lamblia intestinalis: a new pathogen with possible link to Kikuchi-Fujimoto disease. An additional element in the disease jigsaw.

A 16‐year‐old Caucasian girl of Albanian origin was admitted to the hospital complaining of intermittent fever (38u2003°C) for a week, nausea, vomiting, and abnormal laboratory findings (elevated serum aminotransferases levels AST/ALT 77/40u2003U/l and erythrocyte sedimentation rate 80u2003mm/first hour, as well as leukopenia 2.5u2003×u2003103/mm3), which were found in a blood examination. Physical examination revealed slight hepatomegaly and splenomegaly, as well as cervical and axillary lymphadenopathy. A diagnostic open lymph node biopsy was performed and Kikuchi–Fujimoto disease (KFD) was established based on the characteristic histological pattern. Other abnormal laboratory findings were C‐reactive protein 6.8u2003mg/dl and serum lactate dehydrogenase 900u2003U/l. Her history included a diarrhoea syndrome 2 months before the present admission, during the summer holidays, for which she was treated with metronidazole. At that time, characteristic cysts of giardia lamblia intestinalis were observed in the stools. Herein, we present this case hypothesising that the protozoal infection caused by the giardia lamblia intestinalis was probably triggering an immune response leading to KFD. The patients age in combination with this firstly reported protozoal pathogen, as a triggering agent leading to KFD, consist a very interesting originality. Additionally, some review data is also given.

Lung, Pleural and Colon Actinomycosis in an Immunocompromised Patient: A Rare Form of Presentation

Actinomycosis is caused by gram-positive filamentous organisms of the genus Actinomyces, which may spread through trauma. Most commonly, it is a cervicofacial disease due to dental infection or a thoracic disease secondary to aspiration of foreign bodies. Primary abdominal infection usually follows some form of mucosal disruption. Any organ of the human body may be involved so that a wide range of symptoms may be present. We report a rare form of actinomycosis involving the lung, pleura and colon concomitantly in an immunocompromised patient. A fine needle aspiration from a lung lesion detected the characteristic sulfur granules, and a pleural effusion culture confirmed the diagnosis. Clinical manifestations and treatment are discussed. Actinomycetes are rarely opportunistic agents in immunocompromised patients; thus the disease deserves special attention in those patients.

Low selenium levels in serum and increased concentration in neoplastic tissues in patients with colorectal cancer: Correlation with serum carcinoembryonic antigen

There is growing evidence to show that administration of selenium (Se) is associated with a substantial reduction in the incidence and mortality of various cancer types such as skin, prostate, lung, and colorectal cancer (CRC) as well as in sarcomas in both animals and humans [1,2]. Epidemiological studies have shown a reduced risk for the same neoplasms for people living in geographic areas with comparatively high soil Se levels. Similarly, epidemiological and experimental studies suggest an inverse relationship between intake of dietary Se and/or a low-fat intake and CRC risk [3]. CRC is one of the leading causes of cancer-related deaths. Approximately 95% of cases are sporadic. Early detection and prevention are the two most important considerations facing CRC. Low Se intake and plasma levels have been implicated in the multistep process of colorectal carcinogenesis. However, their relationship remains elusive and intriguing [3 /5]. There are studies suggesting that selenium supplementation decreases the cyclooxygenase-2 (COX-2) protein and PGE-2 levels in cancer cells and increases the efficacy of cetuximab in patients with advanced CRC [6 /8]. Material and methods

Inhibition of benzo(a)pyrene-induced carcinogenesis by vitamin C alone and by vitamin C/vitamin E and selenium/glutathione

The reduction on peroxidation caused by benzopyrenes by some naturally occurring antineoplastic agents was studied in this experimental work. Inhibition/reduction of experimental carcinogenesis induced by benzo(a)pyrene by vitamin C alone and by vitamin C/vitamin E and selenium/glutathione was attempted in 224 female Wistar rats divided in four groups. Injected with 10.08 mL benzo(a)pyrene, the animals were treated with some naturally occurring substances like vitamin C alone and a combination of anticarcinogens. By calculating the carcinogenic potency of benzo(a)pyrene and the anticarcinogenic potency of substances used as well as histological examination of developed tumors and survival time of treated animals, it was found that vitamin C exerts a significant anticarcinogenic effect of 8.3 units and that the combination of the two anticarcinogens used produced a significant prolongation of the animals survival time with anticarcinogenic potency of 22.1 and 22.2 units, respectively. This is considered a potent anticarcinogenic effect. The question of an additional supportive administration of such agents complementary to the conventional cancer chemotherapy in humans is raised. Of course, further studies are needed.

Infectious mononucleosis, diffuse pneumonia and acute respiratory failure in an elderly woman.

Infectious mononucleosis (IM) is a benign disease and is frequently associated with mild respiratory symptoms. The pulmonary manifestations rarely dominate the clinical picture. We report a case of an older adult patient with IM who developed diffuse pneumonia and acute respiratory failure. The diagnosis of IM was confirmed serologically, whereas other possible causes of pneumonia were excluded in this study. Pulmonary manifestations of IM are discussed, and the atypical features that may be seen in older adults are simultaneously reviewed.

Left atrial myxoma prolapsing into the left ventricle. Case report and review of the literature.

Cardiac myxomas are rare tumors which may present differently. Left atrial myxoma is an entity from anatomopathological and clinical aspects. To the best of our knowledge, only 2 cases of infected left atrial myxomas treated surgically have been reported in the last 6 years. Herein, we present a patient with a left atrial myxoma prolapsing into the left ventricle in the diastolic phase, which was infected with Streptococcus viridans. Combined therapy, consisting of surgical management and antimicrobial therapy, was used. Clinical presentation, diagnosis and treatment are reviewed.

An increase in creatine kinase secondary to acute pancreatitis: a case report

Creatine kinase (CK) activity is found in high concentrations in skeletal muscle, cardiac muscle and brain. Here, we describe a 64‐year‐old woman with acute pancreatitis and elevated serum CK activity. This association is extraordinarily rare. In particular, laboratory findings which were found to be abnormal were serum CK 4.150u2003U/l (peaked 1 day after admission) with the CK‐MB fraction being less than 5%, lactate dehydrogenase (LDH) 424u2003U/l, serum lipase 1.265u2003U/l and serum amylase 1.105u2003U/l. Some data regarding the phenomenon of acute pancreatitis and elevated serum CK activity are given.