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Biomedical subjects

M Elisaf

Publications and source records attributed to M Elisaf.

126 records · Page 7Linked to original sources
PubMed1992

Hemorrhagic fever with renal syndrome in an endemic area of Greece.

From 1983 to 1990, 32 patients with hemorrhagic fever with renal syndrome (HFRS) were admitted to our hospital. The diagnosis was confirmed by high IgM type titers of antibodies to Hantaan virus. All patients presented with serum and urine abnormalities suggesting renal involvement. Serum creatinine was elevated and ranged between 1.8 and 14.3 mg/dl. Proteinuria ranged between 0.5 and 6.4 g/24 h. Seven patients died due to shock or hemorrhage, while 6 patients were supported by hemodialysis or peritoneal dialysis. Five of them had a complete recovery. Two patients were discharged with some degree of renal impairment which remained stable 12-15 months later. Kidney biopsy in the first patient performed 1 year after his discharge revealed some degree of interstitial fibrosis and tubular atrophy as well as an area with ischemic and sclerosed glomeruli. We conclude that HFRS in Greece is a severe disease with a high mortality rate. The disease may cause chronic renal failure in a limited number of patients.

Adult↗
PubMed1992

Effects of isradipine on hypertension and renal hemodynamics.

The safety and efficacy of isradipine as well as its long-term effects on renal hemodynamics were evaluated in a study of 17 patients with mild-to-moderate essential hypertension and normal or slightly impaired renal function. After a 4-week placebo period, isradipine was administered according to a schedule of increasing dosages ranging from 1.25 to 5 mg twice daily. During treatment and at the latest follow-up (at 6 months), isradipine was found to lower blood pressure (diastolic and systolic) significantly. There were no significant side effects or changes in blood chemistry during treatment. Plasma renin activity and serum aldosterone were slightly raised whereas the glomerular filtration rate, renal plasma flow, and filtration fraction were significantly raised at the latest follow-up compared with the pretreatment levels.

Adult↗
PubMed1991

Antibodies against hepatitis C virus (anti-HCV) in haemodialysis patients: association with hepatitis B serological markers.

Hepatitis C virus (HCV) seems to be the main causative agent of the parenterally transmitted non-A, non-B hepatitis and the detection of anti-HCV may be a marker of ongoing infection with this virus. This study was undertaken to determine the frequency of anti-HCV in 51 haemodialysis patients of our renal unit. In addition association of these antibodies to sex, history of blood transfusions, and duration on haemodialysis, as well as to serological markers of hepatitis B virus infection, was applied. Enzyme-linked immunosorbent assay (ELISA), were used for the detection of all serological markers. Nine of the 51 (17.6%) haemodialysis patients had anti-HCV. The presence of anti-HCV was related to male sex. Although seropositive patients were transfused more often than seronegatives, this difference is not statistically significant. The presence of anti-HCV was associated with the duration of haemodialysis. The majority of anti-HCV patients had serological markers of previous HBV infection, in contrast to seronegative patients.

Adolescent↗
PubMed1991

Nephrocalcinosis in Sjögren's syndrome: a late sequela of renal tubular acidosis.

Sjögren's syndrome (SS) is an autoimmune exocrinopathy that develops into systemic autoimmune disease in 25% of patients, leading to general complications, one of which is kidney involvement. It presents mainly as interstitial nephritis, disclosed by hyposthenuria, distal renal tubular acidosis (RTA) and diabetes insipidus. We here describe five cases of SS with type-1 RTA (hyperchloraemic metabolic acidosis with an anion gap and alkaline urine pH) who developed nephrolithiasis, nephrocalcinosis and renal insufficiency. Hypercalciuria due to acidosis was the main nephrocalcinosis-prone factor in four patients; four subjects displayed diminished renal concentrating capacity, and two had hypokalaemia.

Acidosis, Renal Tubular↗
PubMed1991

Atrophie blanche. Clinical diagnosis and treatment.

In this report, we describe 11 Greek patients with atrophie blanche (AB). All patients had characteristic skin lesions: petechial or purpuric papules or hemorrhagic bullae, that became necrotic and formed ulcers which in turn, became atrophic scars with hyperpigmentation of the surrounding skin. The majority of patients presented these skin lesions on the lower limbs. Two had idiopathic AB, 3 in association with venous insufficiency of the lower extremities and 6 with livedo reticularis (LR) and/or Raynaud's phenomenon (RP). Prior to our evaluation, most of these patients were diagnosed as having skin vasculitis and were treated with prednisone and/or cyclophosphamide. We conclude that AB is a distinct clinical entity with characteristic skin lesions affecting the legs. The disease is associated mainly with LR and RP. Very careful clinical assessment is needed to avoid incorrect diagnosis and unnecessary and potentially harmful therapeutic intervention.

Adult↗
PubMed1991

Sjögren's syndrome in patients with the CREST variant of progressive systemic scleroderma.

Twenty-three patients with the CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia) variant of progressive systemic sclerosis, were clinically, histopathologically and serologically examined for the presence of Sjögren's syndrome (SS). Fourteen were found to be positive. No significant difference could be demonstrated between them and the remaining 9. Characteristics of patients with CREST were compared with those of 29 randomly chosen patients with primary SS. Parotid gland enlargement was more frequently present (p less than 0.01) in the latter than in the former. Virtually no patients with CREST with SS had antibodies to Ro(SSA)/La(SSB).

Autoantibodies↗
PubMed1989

Survival after severe iatrogenic hypernatremia.

The case of a 24-year-old woman who survived without subsequent neurological damage after severe iatrogenic hypernatremia is presented. This previously healthy woman who had given birth with an uncomplicated delivery developed hypernatremia (serum sodium, 178 mmol/L) after erroneous infusion of hypertonic sodium solution.

Adult↗
PubMed1986

Kidney involvement in primary Sjögren's syndrome.

Kidney involvement is well recognized extraglandular manifestation of primary Sjögren's syndrome. The most common histopathological lesion is an interstitial lymphocytic infiltrate with tubular atrophy and fibrosis. In addition, immune complex associated glomerulonephritis has been reported in sporadic cases with primary Sjögren's syndrome. Here we present our experience on kidney involvement in 36 Greek patients with primary Sjögren's syndrome. The following routine renal laboratory tests were performed in all patients: serum creatinine, creatinine clearance, 24 hour urine protein excretion, urinalysis and plain film of the abdomen. These tests revealed two cases with nephrolithiasis and two with severe proteinuria (24 hour urine protein greater than 3.5 g). Kidney histology in the patients with proteinuria was compatible with membranous and membranoproliferative glomerulonephritis respectively. In fifteen randomly selected patients urinary acidification was studied before and after acute acid loading test (oral administration of NH4Cl). Renal tubular acidosis was found in five patients (one with complete and four with incomplete type). Seven patients voluntarily accepted renal biopsy; five of those had mild form of interstitial nephritis. Two of these patients had renal tubular acidosis. In conclusion, renal involvement (clinical and subclinical) is commonly found in primary Sjögren's syndrome patients.

Acidosis, Renal Tubular↗
PubMedDate not supplied

Cutaneous manifestations in brucellosis: case report and review of the literature.

Brucellosis is a classical common zoonotic disease of worldwide distribution. Skin complications are infrequent and affect less than 5% of patients with brucellosis, although they may occasionally occur during the clinical course of the disease. Here, we report a case of a shepherd presenting with fever and a diffuse maculopapular rash due to Brucella melitensis infection, and we provide a review of the relevant literature.

Agricultural Workers' Diseases↗
PubMedDate not supplied

Severe hypomagnesemia and hypoparathyroidism in Kearns-Sayre syndrome.

Kearns-Sayre syndrome (KSS) is a multisystem mitochondrial disorder characterized by the invariant triad: onset before 20, progressive external ophthalmoplegia and pigmentary retinal degeneration, plus at least one of the following: complete heart block, cerebellar dysfunction and CSF protein >100 mg/dl. Autopsies from patients with KSS revealed widespread tissue distribution of mitochondrial (mt) DNA deletions. These deletions result in significantly lower activities of the enzymes of the respiratory chain. KSS has been associated with a variety of endocrine and metabolic disorders in <10% of patients, while renal tubular involvement is extremely rare. We present an 18-year-old girl with KSS who developed hypoparathyroidism and renal tubular dysfunction with inappropriate mangesiuria and kaliuria. We further discuss the renal tubular damage in KSS emphasizing its pathophysiology and clinical phenotype, and review the possible mechanisms of hypoparathyroidism in KSS.

Adolescent↗
PubMedDate not supplied

Prevention and treatment of the metabolic syndrome.

The prevalence of the metabolic syndrome is increasing owing to lifestyle changes leading to obesity. This syndrome is a complex association of several interrelated abnormalities that increase the risk for cardiovascular disease and progression to diabetes mellitus (DM). Insulin resistance is the key factor for the clustering of risk factors characterizing the metabolic syndrome. The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III defined the criteria for the diagnosis of the metabolic syndrome and established the basic principles for its management. According to these guidelines, treatment involves the improvement of the underlying insulin resistance through lifestyle modification (eg, weight reduction and increased physical activity) and possibly by drugs. The coexistent risk factors (mainly dyslipidemia and hypertension) should also be addressed. Since the main goal of lipid-lowering treatment is to achieve the NCEP low-density lipoprotein cholesterol (LDL-C) target, statins are a good option. However, fibrates (as monotherapy or in combination with statins) are useful for the treatment of the metabolic syndrome that is commonly associated with hypertriglyceridemia and decreased high-density lipoprotein cholesterol (HDL-C) levels. The blood pressure target is < 140/90 mm Hg. The effect on carbohydrate homeostasis should possibly be taken into account in selecting an antihypertensive drug. Patients with the metabolic syndrome commonly have other less well-defined metabolic abnormalities (eg, hyperuricemia and raised C-reactive protein levels) that may also be associated with an increased cardiovascular risk. It seems appropriate to manage these abnormalities. Drugs that beneficially affect carbohydrate metabolism and delay or even prevent the onset of DM (eg, thiazolidinediones or acarbose) could be useful in patients with the metabolic syndrome. Furthermore, among the more speculative benefits of treatment are improved liver function in nonalcoholic fatty liver disease and a reduction in the risk of acute gout.

Adipocytes↗
PubMedDate not supplied

The control of dyslipidemia in outpatient clinics in Greece (OLYMPIC) Study.

The objective of this study was to determine the proportion of Greek patients referred to outpatient clinics for dyslipidemia who achieved the low-density lipoprotein cholesterol (LDL-C) goal defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guidelines, using lifestyle changes, lipid-lowering drug treatment (LLDT), or both. Adult patients with dyslipidemia, who had been receiving a hypolipidemic diet and/or LLDT for at least 3 months were assessed in a multicenter study performed at 66 sites across Greece. Patients were followed up for an additional 3-month treatment period. Lipid levels were recorded at baseline and at the end of the study. The primary endpoint was the proportion of patients achieving their individual LDL-C target at the end of the study, according to their coronary heart disease (CHD) risk status or its equivalents, as defined by the NCEP-ATP III guidelines. Multivariate logistic models were used to identify determinants of undertreatment. The study included 2,660 adults (20-75 years) from 7 regions of Greece. Of the evaluable sample (n = 2,211; men 51%; mean age 62 +/-9 years) 81% were receiving LLDT (96% with statins and 3% with fibrates), 44% had a history of CHD, 61% arterial hypertension, 36% diabetes, and 26% a family history of premature CHD. Overall, 6% were at low CHD risk, 30% at medium CHD risk, and 63% at high CHD risk. At the end of the study, 26% of all patients and 30% of those receiving LLDT achieved the NCEP-specified LDL-C target levels. The percentage of patients at LDL-C goal according to CHD risk status was: low risk 67% (95% CI = 59-75), medium risk 29% (95% CI = 26-33), and high risk 20% (95% CI = 18-22). Statins proved to be more effective than fibrates (p <0.0001). Atorvastatin-treated subjects (n = 1,222, mean dose 19 mg/day) attained the LDL-C target (31% of the cases) at a higher rate than those receiving other LLDT (n = 574, 26% at target, p <0.01) or not receiving drug treatment (n = 415, 8%, p <0.001). This outcome was more evident in the high-CHD risk group (n = 1,402, 26% with atorvastatin vs 16% with other LLDT and 3% not receiving LLDT attained the LDL-C goal, ANOVA, p <0.001). The majority of dyslipidemic patients receiving LLDT, mainly those with high-CHD risk, are not achieving the NCEP LDL-C target. This is mainly explained by inadequate dose titration to ensure target goals are met. Promoting healthy lifestyle and appropriate LLDT (potent statins with sufficient dose titration) must be implemented to ensure that patients attain LDL-C treatment goals and thus benefit from the reduction in individual CHD risk.

Adult↗
PubMedDate not supplied

Acid-base and electrolyte abnormalities in febrile patients with bacteraemia.

OBJECTIVES: Very commonly febrile patients with bacteraemia develop a variety of acid-base and electrolyte disturbances which play a significant role in the morbidity and mortality of these patients. This study was undertaken to describe the pathogenetic mechanisms of these abnormalities in febrile patients with bacteraemia. METHODS: Fifteen febrile patients with bacteraemia, aged 24-62 years, were studied. In all patients blood cultures revealed Gram-negative rods. None of them had septic shock, diabetes mellitus, renal or liver failure and none was receiving drugs influencing acid-base balance and electrolyte levels or was a heavy alcohol consumer. RESULTS: Nine patients had respiratory alkalosis, which was possibly due to bacterial toxins, while the remaining 6 had a wide-gap metabolic (lactic) acidosis coexisting with respiratory alkalosis. Hypokalaemia was found in four patients and was mainly due to respiratory alkalosis. However, kaliuria due to hypomagnesaemia contributed to hypokalaemia in 2 patients. Hypomagnesaemia was detected in 3 patients and was attributed to respiratory alkalosis as well as to magnesiuria induced by metabolic acidosis or phosphate depletion. Hypophosphataemia was found in 5 patients who also had respiratory alkalosis and/or phosphaturia due to metabolic acidosis or hypomagnesaemia. Finally, one patient had multifactorial origin hypocalcaemia. CONCLUSION: Febrile patients with bacteraemia develop a number of acid-base and electrolyte disturbances attributed to various pathogenetic mechanisms.

Acid-Base Imbalance↗
PubMedDate not supplied

The beneficial effect of tamoxifen on serum lipoprotein-A levels: an additional anti-atherogenic property.

It has recently been suggested that increased lipoprotein (a) levels are an independent risk factor for coronary heart disease. It has also been reported that tamoxifen can induce changes in blood lipid values. In this prospective study we investigated the long term effects tamoxifen on the lipid profile, focusing on lipoprotein (a) levels. Thirty-eight postmenopausal women with breast cancer treated with tamoxifen at a dose of 20 mg daily were studied. The mean age was 61 years. Serum lipoprotein (a) levels and lipid parameters (total cholesterol, high and low density lipoprotein cholesterol, triglycerides, apolipoprotein A-I and B) were measured after an overnight fast on the 1, 3, 6 and 9 month of tamoxifen treatment. A progressive fall in median lipoprotein(a) levels from 8 mg/dl to 3 mg/dl (p < 0.001) was observed. In addition, a significant decrease in the total and low density lipoprotein cholesterol and in apolipoprotein B, as well as an increase in apolipoprotein A-l were also noticed. It is concluded that our data on serum lipoprotein(a) levels agree with the beneficial anti-atherogenic effects of tamoxifen administration on lipoproteins.

Aged↗
PubMedDate not supplied

Is CAPD atherogenic?

Explore the source record for details and available documents.

Arteriosclerosis↗