Niki E. Tsesmeli

Trend in incidence of cardiovascular risk factors in elderly and over-aged stroke patients between 2003 and 2007 in Greece

The aim of this study is to identify the main cardiovascular risk factors (CRFs) in patients over 65 years with ischemic stroke. This is a retrospective study in 175 patients that were hospitalized in our department due to ischemic stroke in the period 2006-2007. The patients were divided in two groups: Group I--elderly (65-80 years) and Group II--over-aged (>or=81 years). The results were compared with a similar study performed in our department in the period 2002-2003 in 160 ischemic stroke patients. Statistical analysis was made by the chi2-test. Hypertension, either alone or in combination with other CRFs, constitutes the main CRF. Diabetes mellitus (DM) is not frequently the sole CRF but its coexistence with other CRFs ranks DM as the second most important CRF, with the largest percentage in the elderly. Dyslipipidemia is 4th CRF in order following the coronary heart disease (CHD). Taking into account that the provision of acute therapeutic intervention in elderly and over-aged ischemic stroke patients is in most cases difficult, because of their age and the high risk of thrombolysis in these patients, there is increased need to focus on primary prevention of ischemic stroke by treating associated CRF.

Detection of CD55- and CD59-deficient granulocytic populations in patients with myelodysplastic syndrome.

Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by absence of CD55 and CD59 from the surface of affected cells. PNH has been associated with myelodysplastic syndromes (MDS). The aim of our study was to estimate the prevalence of the PNH clone in MDS patients by detecting CD55 and CD59 deficiency. We studied 90 MDS patients: 19 patients with RA, 15 with refractory anemia with ringed sideroblasts (RARS), 18 with refractory anemia with excess of blasts (RAEB), 17 with refractory anemia with excess of blasts in transformation (RAEB-t), and 21 with chronic myelomonocytic leukemia (CMML). Twenty healthy individuals were also studied as the control group. We studied the PNH clone on granulocytes of these patients with the aid of flow cytometry. CD55- and CD59-deficient granulocytic populations were detected in 15.5% of MDS patients compared to 2.8% of normal individuals. Among the subgroups of the study, significant difference was present in three cases: (1) between CMML and control, (2) between CMML and RA, and (3) between CMML and RARS. These data indicate a possible association between PNH phenotype and MDS. MDS patients of worse prognosis (CMML) express more strongly the PNH clone compared to those of better prognosis (RA and RARS). Perhaps, the examination of MDS patients for the PNH clone by flow cytometry could provide us with a valuable prognostic tool.

Incidence and etiology of acute non-malignant upper gastrointestinal bleeding in northern Greece.

Aim:u2002 To evaluate the incidence and etiology of acute non‐malignant upper gastrointestinal bleeding (ANMUGIB) in northern Greece due to increased use of non‐steroidal anti‐inflammatory drugs (NSAIDs), including low‐dose aspirin (L‐A), exposure and geographical variability of Helicobacter pylori (Hp) seroprevalence.

Colonic toxicity of antidepressants: an unusual case of a 48-year-old patient with transient ischemic colitis

Dear Editor, Colonic toxicity of administered medications is uncommon in clinical practice. Its clinical manifestations can range from colonic pseudo-obstruction to various forms of colitis such as ischemic colitis (IC). A 48-year-old male non-smoking patient presented to the emergency department with a head injury. He reported loss of consciousness and fall, leading to a headache which ceased after taking two tablets of aspirin the day before. He also noted a few hours duration of left lowerquadrant abdominal pain, three bloody diarrheas, and two episodes of vomiting. His medical history included depression under long-term treatment with amitriptyline at a dose of 50 mg daily accompanied by constipation. His general physical appearance was normal. He was found to have a low-grade fever (37.4°C), orthostatic hypotension (blood pressure: 110/70 mmHg at supine position and 85/60 mmHg at upright position) and left lower-quadrant abdominal tenderness. Rectal examination confirmed the presence of blood. His electrocardiogram (ECG) showed sinus tachycardia (110 bpm) and a small prolongation of QT interval. Both chest and abdominal X-rays were normal. His hematological and biochemical tests were unremarkable except for a mild leukocytosis (WBC 12.5×10 /l) with a left shift. His PT/PTT were within normal limits. Stools for bacterial pathogens, ova, and parasites were negative. Abdominal CT scanning demonstrated an irregular wall thickening of the descending colon. Thirty-six hours after his admission, a lower GI endoscopy revealed a 15-cm segment of descending colon involving the splenic flexure with edema, submucosal hemorrhages, superficial ulceration, exudation, and mucosal necrosis. The histology of the inflamed area’s specimens demonstrated full thickness necrosis of the mucosa with a surface exudate. The remnants of lamina propria were edematous with a deeply eosinophilic appearance. The residual crypts were small and reduced in number. The cryptal epithelial cells had lost their mucin and they were flattened and basophilic. Accompanying this cryptal damage was a moderate inflammatory cell infiltrate. Fibrin plugs were noted in mucosal capillaries. The surface epithelium grew over an area of full thickness mucosal ulceration in one small specimen. These findings were consistent with IC. The diagnosis of IC was followed by echocardiography and a 24-h ambulatory electrocardiography, which showed no signs of heart disease. Red cell morphology and thrombophilic screening for protein C, protein S, factor V Leyden, antithrombin III and antiphospholipid antibodies were normal. Autoimmune serology, including C3, C4, c-ANCA, p-ANCA, antinuclear antibodies, anti-ds DNA, antiSm, anti-Ro (SS-A) and anti-La (SS-B), was negative. Infection with CMVor HBV virus were ruled out through serological testing. His oral intake was temporarily stopped. Amitriptyline was discontinued. Intravenous hydration and combined antibiotic treatment with ciprofloxacin 400 mg 1×2 iv and metronidazole N. E. Tsesmeli . C. G. Savopoulos (*) . D. P. Koliouskas . A. I. Hatzitolios . D. T. Karamitsos 1st Medical Propedeutic Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, PC 546 36 Thessaloniki, Greece e-mail: chrisavop@hotmail.com Tel.: +30-2310-994783 Fax: +30-2310-285128

Sodium-lithium countertransport activity in healthy, dyslipidemic, and hypertensive individuals.

The aim of our study was to investigate the role of dyslipidemia on red blood cell sodium-lithium countertransport activity in healthy and hypertensive individuals. A total of 128 Caucasian individuals, aged 20 to 60 years old, were divided into 4 groups: dyslipidemic/ hypertensive, dyslipidemic/normotensive, normolipidemic/hypertensive, and normolipidemic/ normotensive (controls). Sodiumlithium countertransport activity was determined based on the Canessa et al method. Sodium-lithium countertransport activity was significantly higher in all patient groups compared with controls (P < .001) and similar in the 3 patient groups. Sodium-lithium countertransport activity was significantly and positively associated with triglyceride levels (P < .001), body mass index (P < .001), total cholesterol levels (P = .001), and systolic (P = .001) and diastolic blood pressure (P = .001). In multivariate regression analysis, triglycerides made the largest contribution to sodiumlithium countertransport variation among the variables tested (R 2 = 0.273). Our results suggest that dyslipidemia affects sodium-lithium countertransport activity independently of essential hypertension and even to a greater extent than hypertension.