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S Raptis

Publications and source records attributed to S Raptis.

At least 19 recordsLinked to original sources
PubMed2006

Once-daily insulin glargine administration in the morning compared to bedtime in combination with morning glimepiride in patients with type 2 diabetes: an assessment of treatment flexibility.

AIMS: To compare the incidence of nocturnal hypoglycemia and glycemic control following bedtime or morning insulin glargine (LANTUS; glargine) plus glimepiride. METHODS: In this 24-week, multinational, open, randomized study, 624 patients with type 2 diabetes poorly controlled on oral therapy received morning or bedtime glargine plus morning glimepiride (2, 3 or 4 mg) titrated to a target fasting blood glucose level < or = 5.5 mmol/l. RESULTS: The incidence of nocturnal hypoglycemia was equivalent between the two groups, with morning glargine non-inferior to bedtime (13.0 VS. 14.9 % of patients; between-treatment difference -1.9 %; one-sided 95 % confidence interval -100 %; 2.84 %). At endpoint, similar improvements in glycemic control were observed with morning compared to bedtime glargine: HbA1c: -1.65 +/- 1.21 VS. -1.57 +/- 1.16 %; p = 0.42; fasting blood glucose: -4.25 +/- 2.82 VS. -4.48 +/- 2.75 mmol/l; p = 0.08. The endpoint mean daily glargine dose was comparable (34.7 +/- 17.4 VS. 32.4 +/- 17.0 IU; p = 0.15), and there was no significant between-treatment difference in the change in body weight (2.1 VS. 1.8 kg; p = 0.39). CONCLUSIONS: Once-daily glargine can be administered in a flexible morning or bedtime regimen (plus morning glimepiride) to achieve good glycemic control without any difference in hypoglycemia.

Adult↗
PubMed2005

Trends in the presentation and surgical management of the acute diabetic foot.

BACKGROUND: This study examines trends in the presentation and surgical management of acute diabetic foot problems in a single institution. METHOD: Prospective audit of all diabetic patients who had a primary procedure for critical lower limb ischaemia (CLI) and/or foot sepsis between 1st January 1990 and 31st December 2002. Primary and secondary intervention, mortality and limb salvage rate within 6 weeks of the index procedure were recorded. RESULTS: There were 661 patients (417 men and 244 women of median age 69, range 31-99, years) with 799 affected limbs. CLI alone was present in 625 (78%) limbs, combined CLI and foot sepsis in 53 (7%) and foot sepsis alone in 121 (15%). The primary intervention was minor amputation in 323 (40%) limbs, revascularisation in 288 (36%), major amputation in 185 (23%) and sympathectomy in three limbs. Within 6 weeks, 125 (16%) limbs required secondary intervention, the peri-procedural mortality rate was 38 of 924 (4%), and the limb salvage rates for patients with CLI, combined CLI and sepsis and sepsis alone were 66, 66 and 80%, respectively. There was a significant decline in the proportion of patients presenting with CLI alone and a significant increase in the proportion presenting with combined CLI and sepsis and sepsis alone. In patients with CLI alone, there was a significant increase in the primary major amputation rate and a significant decline in the minor amputation rate with no significant change in the revascularisation rate. CONCLUSION: There has been a progressive decline in the proportion of patients presenting with CLI alone and a greater proportion of patients presenting with an element of foot sepsis. In patients with CLI alone, the primary major amputation rate has increased at the expense of a decline in minor amputation rate.

Acute Disease↗
PubMed2005

Intra-abdominal packing for uncontrollable haemorrhage during ruptured abdominal aortic aneurysm repair.

OBJECTIVE: Intra-abdominal packing is a valuable adjunct in patients with abdominal trauma and uncontrollable bleeding but few data exist regarding early and late outcome associated with this technique in patients with ruptured abdominal aortic aneurysm (AAA). METHODS: Interrogation of a prospective vascular surgical database identified 23 patients (22 men; median age 69, range 59-82, years) with ruptured AAA who required intra-abdominal packing for control of coagulopathic haemorrhage after insertion of an aortic graft between January 1982 and December 2003. Co-morbidity, operative and outcome data were retrieved. RESULTS: Haemostasis was achieved and packs were removed within 48 h in 20 patients. In those patients who had a graft inserted, the peri-operative mortality rate was 12 of 23 (52%) patients (vs. 172 of 455 (38%) patients who were not packed, NS). Three (13%) patients developed early intra-abdominal sepsis, which was universally fatal: graft-enteric fistula, intra-abdominal abscess with necrotizing fasciitis of the abdominal wound, and infected retroperitoneal haematoma. Two of 11 (18%) survivors developed late graft-related infective complications: major aortic graft infection at 6 months and symptomatic infected para-anastomotic aortic false aneurysm at 39 months. Early and late intra-abdominal infective complications were significantly more common in patients who were packed than in those who were not (packed: five of 23, 22% vs. non-packed: five of 455, 1%; p < 0.001). CONCLUSION: These data demonstrate that intra-abdominal packing in coagulopathic patients with ruptured AAA can achieve an acceptable survival rate. However, this technique may be associated with an increased incidence of early and late intra-abdominal infective complications.

Aged↗
PubMed2005

Existing delays following the presentation of ruptured abdominal aortic aneurysm allow sufficient time to assess patients for endovascular repair.

OBJECTIVES: The greatest benefit of endovascular AAA repair (EVAR) may be in the management of rupture (RAAA). However, the detailed anatomical assessment required for EVAR has lead to concerns of surgical delay and death during cross-sectional imaging. In this study, we prospectively assessed patients with RAAA and correlated time of hospital arrival with time of surgery or death to ascertain whether these concerns are justified. METHODS: All patients presenting with RAAA between October 2000 and December 2002 were included. The hospital arrival time, onset of surgery or time of death, were recorded, as were demographic and physiological parameters. RESULTS: One hundred consecutive patients were studied, median age 75 years (range 54-94). Seventy-nine patients underwent attempted conventional surgical repair and 21 were palliated. The median delay from arrival to operation was 159 min (range 16-1450 min). Mortality in the surgical group was not affected by the length of delay (p = 1.0) or by CT scanning (p = 0.34). The median time from arrival to death in the non-surgical group was 435 min (15 min-6 days). CONCLUSIONS: Most patients who present with ruptured AAA experience a significant delay prior to surgery. This study suggests it is safe to assess the majority of RAAA patients for EVAR.

Aged↗
PubMed2005

A novel p27 gene mutation in a case of unclassified myeloproliferative disorder.

P27 encodes a member of Cip/Kip family of cyclin dependent kinase inhibitors, the inactivation of which has been implicated in the pathogenesis of various hematological neoplasias. We report on a novel point mutation of this gene identified in a case of unclassified myeloproliferative syndrome consisting of a T --> C transversion at 821bp of p27 exon 1, resulting in a Ile --> Thr substitution at codon 119. The analysis of larger number of cases as well as the effect of this mutation on protein's function will help to clarify its significance in the pathogenesis of myeloproliferative syndromes.

Cell Cycle Proteins↗
PubMed2004

Individualized risk management in diabetics: how to implement best practice guidelines--design and concept of the IRIDIEM studies.

The prevalence of type 2 diabetes mellitus is rising rapidly in all developed countries, particularly in the growing population of persons >50 years of age. As a dangerous consequence, this is accompanied by a proportionate increase in the incidence of chronic renal disease. Evidence-based medicine has shown that tight blood glucose control can delay the onset and retard the progression of diabetic complications, and while it is a challenge to closely manage the complexity of diabetes, it is more difficult to effectively treat the multiple associated comorbidities that develop. Best practice guidelines support early intervention and aggressive treatment of hypertension, hyperglycaemia, proteinuria, hypercholesterolemia, and anaemia. To date, guideline-based management has been proven to be difficult. This article describes the concept of the IRIDIEM studies. The objective of these studies is to endorse and facilitate the use of current best practice guidelines for the management of frequent comorbid diseases and established risk factors in the treatment of type 2 diabetes associated with chronic kidney disease. Additionally, IRIDIEM will assess the impact of this improved disease management model on the progression of chronic kidney disease that can result from electronically prompting clinicians with evidence-based treatment advice.

Diabetic Nephropathies↗
PubMed2004

Endovascular treatment of abdominal aortic aneurysm.

BACKGROUND: Endovascular repair of abdominal aortic aneurysm has become widely used. Supporters claim high success rates, few complications and a dramatically reduced hospital stay. However, endoleak, endotension and reports of endoprosthesis rupture are causes of concern. METHODS: A Medline search was undertaken to identify articles on endovascular repair of abdominal aortic aneurysm. Additional papers were identified by manual scanning of the references from key articles. RESULTS AND CONCLUSION: Endoleak is a potentially serious complication of the endovascular technique and occurs in a significant proportion of patients. It is still not possible to judge whether the presence of an endoleak alone signifies failure of treatment, and the long-term durability of prosthetic covered stents is unknown. However, endovascular repair does appear to confer a degree of protection from rupture although patients must be advised of the need for life-long imaging surveillance and, perhaps, further intervention.

Aortic Aneurysm, Abdominal↗
PubMed2003

Absence of MLL gene rearrangement in de novo myelodysplastic syndromes (MDS).

The Mixed Lineage Leukemia (MLL) gene has been identified in 11q23 translocations. The aim of the present study is the investigation of the frequency of MLL gene rearrangements in cases of de novo myelodysplastic syndromes (MDS). Sixty-two patients with de novo MDS were included in the analysis. The detection of MLL gene rearrangements was performed by Southern blot. Clonal karyotypic abnormalities were found in 15/50 (30%) cases. 11q23 abnormalities were not detected. One case with RAEB and a complex karyotype presented a del (11)(q13); further analysis by FISH revealed loss of one copy of MLL gene in all metaphases. Southern blot revealed germline bands in all cases using Eco RI and in 61/62 cases with Bam HI. The case with RAEB and a del (11)(q13) revealed a rearranged band following only Bam HI digestion, but not Eco RI. Rearrangements of MLL gene within exons 5-9 were not identified in this series of adult de novo MDS, indicating that this molecular abnormality is not involved in the pathogenesis of this group of hemopoietic disorders.

Blotting, Southern↗
PubMed2003

Monoclonal gammopathies in B-cell non-Hodgkin's lymphomas.

The association of monoclonal gammopathy (MG) with B-cell non-Hodgkin's lymphomas (NHL) is a well known phenomenon. The aim of the present work was to study the incidence, type of monoclonal component and prognostic significance of MG in a population of 255 cases with B-cell NHL. Among 255 evaluable patients with B-cell NHL, 145 were males and 110 females with a median age of 58 years (range 18-85). There were 166 patients with the various subtypes of aggressive (intermediate/high grade) NHL and 89 with the various subtypes of low risk. MG was detected in 44 patients (17.2%) with a median age of 61 years (range 23-79). There were 22 cases (8.6%) with IgG type (IgG/(k) 15, IgG/(lambda) 7), 4 cases (1.6%) with (IgA/(k) 3, IgA/(lambda) 1) and 18 cases (7.0%) with IgM (IgM/(k) 12 IgM/(lambda) 6). MG was found in 15.6% of the patients with aggressive NHL, while in low risk NHL the incidence was 20.2% (N.S.). The type of MG according to histological classification was as follows: Aggressive NHL: IgG 17 cases, IgA 2 cases, IgM 7 cases: low risk NHL: IgG 5 cases, IgA 2 cases, IgM 11 cases. The distribution of MG according to stage of the disease was as follows: stage I (4.5%), stage II (18%), stage III (6.8%) and stage IV (70.4%). The median survival of patients with aggressive NHL with MG was 17 months compared to 40 months of those without (P=0.22). Similarly the median survival of patients with low risk NHL and MG was 51.5 months compared to 38.5 months of those without (P=0.90). In conclusion MG was detected in 17.2% of cases with B-cell NHL. IgG-MG was more frequent in cases with aggressive NHL, while IgM in cases with low risk NHL. MG was mostly associated with advanced stage and had not any prognostic significance on survival.

Adolescent↗
PubMed2003

Predicting outcome in ruptured abdominal aortic aneurysm: a prospective study of 100 consecutive cases.

OBJECTIVES: Case selection for surgery in patients presenting with ruptured abdominal aortic aneurysms (RAAA) is often difficult. A previous retrospective review identified five pre-operative risk factors associated with mortality [J Vasc Surg 23 (1996) 123]. In this study we aimed to identify whether these criteria could be usefully applied prospectively in patients presenting with RAAA. METHODS: All patients presenting with RAAA from October 2000 to December 2002 were included. The criteria were recorded with the time they were available and the time surgery commenced. The decision to operate was made on clinical grounds and no patient was refused surgery on the basis of these criteria. RESULTS: One hundred consecutive patients were studied, median age 75 (range 54-94). The operative mortality was 32.9% (26/79 patients). Surgical mortality increased with the number of positive criteria and was 8% (2/24), 24% (7/29), 55% (11/20) and 100% (6/6) for scores, 0, 1, 2 and > or =3, respectively. Age and conscious level were available in every patient. However, an ECG, haemoglobin and creatinine results were only available in 94, 81, and 69%, respectively. CONCLUSIONS: The scoring system accurately predicted operative mortality. The score was available in the majority of cases and may help the surgeon give informed consent to patients and relatives prior to surgical intervention.

Aged↗
PubMed2003

Treatment of intermediate and advanced stage Hodgkin's disease with modified baseline BEACOPP regimen: a Hellenic Co-operative Oncology Group Study.

The purpose of this prospective phase II trial was to investigate the safety and efficacy of a modified baseline BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) regimen in the treatment of intermediate and advanced stage Hodgkin's disease (HD). From October 1997 to November 2001, 51 consecutive, previously untreated patients with stage IIA (bulky), IIB, III, and IV disease were treated with a modified baseline BEACOPP regimen with the etoposide administered i.v. on day 1 and orally at a dose of 100 mg/m2, on days 2 and 3. Each patient was scheduled to receive eight courses of BEACOPP with consolidation radiotherapy to bulky (> or =5 cm) or residual disease. There were 25 males and 26 females with a median age of 32 yr (16-65 yr); 80.3% of the patients had nodular sclerosis HD, 41% had bulky disease (> or =5 cm), 10 were in stage IIA (bulky > or =10 cm), 15 in stage IIB, 19 in stage III, and seven in stage IV. Thirty-seven patients (72.5%) achieved a complete response and 17.6% partial response. No significant difference in overall response rate was observed between patients with: (i) 0-2 vs. > or =3 negative prognostic factors, (ii) in stage II vs. stages III/IV, LDH level, and bulky disease. With a median follow up period of 39.5 months, actuarial 3-yr survival rate is 82% and time to progression rate 72.5%. Treatment with this combination was well tolerated. Grades 3 and 4 leukopenia and neutropenia occured in 26% and 28% of the patients, respectively, whereas in 16.3% of the patients infection was observed. Support with granulocyte colony-stimulating factor was given to 59% of the patients. No case of secondary MDS/leukemia has been observed. The results of the present study demonstrate that the modified baseline BEACOPP regimen with radiotherapy used in our patients was well tolerated and effective therapy for intermediate and advanced stage HD. Further follow up time is required to evaluate long-term toxicity.

Adolescent↗
PubMed2002

Flow cytometric detection of intracellular IL-12 release: in vitro effect of widely used immunosuppressants.

Interleukin 12 (IL-12) is a potent regulator of the Th1/Th2 pathway, enhancing alloantigen-specific immune functions. In the present study, we developed a flow cytometric assay detecting intracellular IL-12 production by human CD14+ monocytes in order to assess the in vitro effects of widely used immunosuppressants, such as cyclosporine (CsA), sirolimus (SRL) and dexamethasone (DXM). For the purpose of the study, a two-step activation procedure was developed involving the preactivation of peripheral blood mononuclear cells (PBMC) with interferon-gamma (IFN-gamma) and reactivation with IFN-gamma and lipopolysaccharide (LPS). All immunosuppressive agents were added at the initiation of the preactivation or the reactivation step. Following this activation protocol, a fourfold to fivefold up-regulation of the percentage of CD14+/IL-12+ cells and of the mean fluorescence intensity was observed. CsA did not significantly affect the intracellular IL-12 release by CD14+ cells, independent of the time point of the addition. SRL exerted an up-regulatory effect when added at the initiation of the IFN-gamma pre-incubation, and this was manifested as a significant increase in the percentage of CD14+/IL-12+ cells. In contrast, DXM effectively repressed both the percentage and the fluorescence intensity of IL-12-producing CD14+ cells when added at the initiation of the reactivation step. Since only the steroid preparation was shown to down-regulate the intracellular release of IL-12, it is tempting to assume that steroid addition in immunosuppressive schemes is beneficial for the suppression of Th1-inducing cytokine production, as well as for the compensation of possible up-regulation induced by other immunosuppressive agents administered concurrently.

Cyclosporine↗
PubMed2002

Atherosclerosis of carotid arteries and the ace insertion/deletion polymorphism in subjects with diabetes mellitus type 2.

BACKGROUND: The aim of the present study was to investigate the association of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism with the ultrasonographically evaluated severity and characteristics of carotid artery atherosclerosis in subjects with diabetes mellitus type 2. METHODS: We assessed 184 subjects with diabetes mellitus type 2, 75 males and 109 females, mean age 61.4+/-7.7 years. All subjects were receiving oral antidiabetic drugs for glycemic control and were free of cardiovascular events. The ACE genotype was analyzed by the polymerase chain reaction (PCR) technique. The ultrasonographic examination of the carotid arteries was performed in both B-mode imaging and Doppler ultrasound. The common carotid artery intima-media thickness was assessed 15-20 mm proximal to the dilatation of the carotid bulb. The atheromatous lesions were classified according to their echogenic characteristics as predominantly echolucent, mixed and predominantly echogenic with under 30, 30-70 and over 70% of the total plaque area echogenicity, respectively. RESULTS: From the total cohort 29 (15.8%) subjects had the II, 86 (46.7%) the ID and 69 (37.5%) the DD ACE genotypes. The mean carotid artery diameter stenosis was 37+/-17%, 43+/-19% and 40+/-20% (p=NS) and the intima media thickness was 0.94+/-0.24 mm, 0.97+/-0.20 mm and 0.98+/-0.20 mm (p=NS) in the II, ID and DD subgroups, respectively. When the echogenicity was analyzed according to the ACE I/D polymorphism, 12 subjects (41.4%), 13 (44.8%) and 4 (13.8%) with II genotype had predominantly echogenic, mixed and predominantly echolucent lesions, respectively. The ID genotype diabetics were found to have predominantly echogenic plaques in 41 cases (47.7%), mixed in 30 (34.9%) and predominantly echolucent in 15 cases (17.4%). From the 69 DD subjects 19 (27.5%) had predominantly echogenic plaques, 26 (37.7%) had mixed and 24 (34.8%) had predominantly echolucent lesions. Predominantly echolucent plaques were more frequently encountered among diabetics with the DD genotype (p<0.05), even after correction for demographic characteristics, the main risk factors of atherosclerosis and blood glucose control. CONCLUSIONS: The ACE genotype seems to be associated with the echogenicity of carotid artery atheromatosis but not with the common carotid artery intima media thickness or the degree of internal carotid artery stenosis in subjects with type 2 diabetes mellitus. The DD genotype may be implicated in the increased cardiovascular risk that characterizes echolucent plaques.

Aged↗
PubMed2001

Massive hemothorax due to intrathoracic extramedullary hematopoiesis in a patient with hereditary spherocytosis.

Extramedullary hematopoiesis (EMH) is a rare disorder, characterized by the appearance of hematopoietic elements outside of the bone marrow, which occurs in patients with chronic myeloproliferative disorders or congenital hemolytic anemias. We report on a 64-year-old man with hereditary spherocytosis, who presented with anemia, jaundice, intrathoracic EMH, and massive hemothorax. The diagnosis of EMH was established after computer tomography (CT)-guided punctuation of the paravertebral mass. The patient underwent splenectomy and thoracic drainage. After 1 year, the patient is in good health, with normal hemoglobin values, and hemothorax has not recurred.

Hematopoiesis, Extramedullary↗
PubMed2001

Closing the loop: the role of audit in reducing groin complications associated with coronary angiography.

BACKGROUND: Local vascular complications of coronary angiography present a significant but often ignored clinical problem. This audit was performed because of a perception that the number of false aneurysms requiring surgical repair was increasing. STANDARD: An acceptable incidence of false aneurysm was derived from series in which ultrasound examinations were only performed if a false aneurysm was suspected (0.06-0.7%). The success rate of ultrasound (US) directed compression ranged from 50% to 93%. ASSESSMENT OF LOCAL PRACTICE: Data were retrieved from cardiology, radiology and vascular surgery databases in addition to case note review. The incidence of false aneurysm was significantly higher than that of historical control groups from the authors' institution (1.5% vs 0.5%, P < 0.05) and in published series used as the standard. The success rate of US directed compression was also poor compared to historical controls (25% vs 55%,P < 0.05) and previously published series. IMPLEMENTATION OF CHANGE: Recommended changes included the use of fluoroscopy to identify the femoral head to avoid low puncture, strict adherence to the existing protocol for sheath removal and the use of adequate analgesia and sedation prior to attempted US compression. REASSESSMENT OF LOCAL PRACTICE: The incidence of false aneurysm fell to that of the standard set by previous studies. US directed compression was successful in 100%. CONCLUSIONS: The audit was successful in that the incidence of false aneurysm fell and the success rate of US directed compression increased, but the specific reasons for the improvements remain unclear.

Aneurysm, False↗