A case-control study of the relationship between smoking, diet, and gallbladder disease.

Eighty-four women with roentgenographically confirmed gallbladder disease and 171 control women hospitalized at a trauma hospital in Athens, Greece, were interviewed regarding demographic, reproductive, smoking, and dietary characteristics. A food-frequency approach was used to elicit consumption of 120 food or beverage items during the period before the onset of the current illness or hospitalization. The patients were substantially less likely to be regular cigarette smokers before the current admission. Additionally the patients reported significantly less frequent consumption of total items contained in the following food groups: sugars; pulses, nuts, beans; fish; and dairy products. On average they also consumed significantly fewer alcoholic beverages. On the other hand, the patients reported more frequent consumption of items in the following food groups: cereals, potatoes, fruits, meats, fats and oils, and coffee/tea. After controlling for confounding between food groups through multiple logistic regression models, the patients were still found to be less frequent consumers of vegetables and alcoholic beverages but more frequent consumers of potatoes and items in the cereal group. These analyses also confirmed the reduced likelihood of the patients being smokers.

Absence of an association between past infection with hepatitis A virus and primary hepatocellular carcinoma.

Serum samples from 77 caucasians of Greek origin with primary hepatocellular carcinoma (PHC) and 77 age- and sex-matched controls were tested for antibody to the hepatitis A virus (anti-HAV). Anti-HAV was detected in 63 patients with PHC (82%) and in 70 controls (91%). These data suggest that past infection with hepatitis A virus is not related to the development of PHC, in marked contrast to the strong association between PHC and HBV.

Biosocial correlates of colorectal cancer in Greece.

One hundred consecutive patients with histologically confirmed colorectal cancer and an equal number of age- and sex-matched orthopaedic patients as hospital controls were interviewed about demographic, socioeconomic, biometric and medical variables. Cholecystectomy was significantly more frequent among cases than controls, but there was no side-predilection of the post-cholecystectomy tumours. The frequency of bowel evacuation was significantly higher among cases, particularly those with rectal cancer, an observation which appears contradictory to the 'prolonged bowel transit time--high colorectal cancer risk' hypothesis. No significant differences were found between cases and controls with respect to socioeconomic status, height and weight, smoking habits, use of laxatives and (for females) parity, age at first pregnancy, and age at menopause; however, cases appeared to be younger at menarche.

Serum immunoglobulins in a rural and an urban population of Greece with special reference to immunoglobulin A.

The serum concentration of immunoglobulins G, A, and M was studied in 390 inhabitants of a rural community and in 204 residents of an urban area of Greece. It was found that serum IgA levels were significantly higher in the rural area where intestinal infections were more prevalent. No significant difference in serum IgG was found between the two groups. IgM was found to be lower among residents of the rural area. The present findings suggest a possible ecological association between increased IgA and chronic exposure to intestinal infection.

Carcinoembryonic antigen in thyroid disease.

Plasma carcinoembryonic antigen (CEA) levels were measured by the Z-Gel technique in 138 patients with benign thyroidopathies, 25 patients with thyroid cancer, and 141 normal persons. Levels were raised (above 5 ng/ml) in 2% of the normal subjects, in none of the patients with benign thyroidopathies, and in 20% of the patients with thyroid cancer. They were considerably raised in all cases of medullary carcinoma of the thyroid but they were also high in other histological types of thyroid cancer. Measurement of plasma CEA may be of value in the preoperative diagnosis and follow-up of patients with thyroid cancer.

Activating mutations in the k-ras gene in ulcerative-colitis and crohns-disease.

Patients with ulcerative colitis (UC) and Crohn's disease have an increased risk for developing cancer of the colon. Mutations in the K-ras gene are relatively frequent in specimens from patients with sporadic colon cancer, but less frequent in cases of cancer complicating ulcerative colitis. In order to study the problem further we used the polymerase chain reaction (PCR) technique followed by a restriction fragment length polymorphism (RFLP) assay, to detect mutations at codon 12 of K-ras in biopsy specimens from patients with UC or Crohn's disease. Six among 27 patients (22.2%) with UC and 2 of the 19 patients (10.5%) with Crohn's disease examined, carried a mutation at codon 12 of K-ras. Our results indicate that mutations in K-ras may be a genetic marker that would reveal the predisposition to colon cancer among this group of patients.

Carcinoma of the ampulla of Vater in Crete. A clinical and ERCP registry over eight years.

BACKGROUND: Carcinoma of the ampulla of Vater is an infrequent tumor that can be diagnosed, early. PATIENTS AND METHODS: Twenty-four patients with histologically proven carcinoma of the ampulla of Vater were retrospectively studied and their data were analyzed. RESULTS: Most common presenting symptoms were jaundice (67%), weight loss (58%), fever and pain (54%). Endoscopic biopsies which were taken in 19 patients revealed carcinoma or dysplasia in 15 patients and were normal for in the rest. Twelve patients were treated with a Whipple's resection, 5 with local resection, 2 with palliative surgery and 2 received a stent endoscopically. During a mean follow-up period of 25 months, (range 1-82) 12 deaths were noted, and one patient was lost during follow-up. CONCLUSIONS: Presenting symptoms, endoscopic and histological findings were similar as in other series. The contribution of duodenoscopy, ERCP and endoscopic biopsy is essential for diagnosis but endoscopic biopsies may be misleading.

Roux-Y choledochojejunostomy and duodenojejunostomy for the complicated duodenal diverticulum.

BACKGROUND: Exclusion of the duodenum by means of transection and Roux-Y duodenojejunostomy has been practiced for the treatment of complicated duodenal diverticulum. However, this method does not divert bile away from the diverticulum, hence the possibility of pancreaticobiliary complications is not eliminated. METHODS: Roux-Y choledochojejunostomy and duodenojejunostomy, for the diversion of bile and food, has been applied for the treatment of pancreaticobiliary complications of duodenal diverticulum in 4 patients. Postoperatively, all patients had endoscopy, HIDA-scintigraphy for the measurement of enterogastric reflux, and assessment of gastric emptying. RESULTS: One year postoperatively, there were no recurrent symptoms of cholangitis or pancreatitis, no anastomotic ulceration was found on endoscopy, there were no complaints of gastric stasis, and enterogastric reflux was not significant. CONCLUSIONS: Roux-Y choledochojejunostomy and duodenojejunostomy for the treatment of the complicated duodenal diverticulum is associated with satisfactory results. Postoperative symptoms attributed to anastomotic ulceration, bile reflux, or gastric stasis are also absent.

Somatostatin for acute severe bleeding from portal hypertensive gastropathy.

OBJECTIVES: To investigate the effect of somatostatin in acute severe bleeding from portal hypertensive gastropathy in 26 cirrhotic patients. METHODS: All patients with signs of acute gastrointestinal bleeding and an upper GI endoscopy (during the first 24 h) indicating overt bleeding from portal hypertensive gastropathy were included in the study. Somatostatin (or the synthetic tetradecapeptide, octreotide) was administered in all cases. Eleven patients received somatostatin and 15 patients received octreotide. An initial injection of 250 microg bolus somatostatin was followed by a continuous infusion of 250 microg/h for 3 days (100 microg and 50 microg/h for octreotide). RESULTS: Somatostatin arrested bleeding in all 26 patients and in 23 there was no hospital relapse. In the remaining three patients the bleeding recurred each time somatostatin infusion was discontinued and arrested again on reinstitution of treatment. In two there was a control of haemorrhage, while the third required a total gastrectomy after repeated episodes. The rebleeding rate in our study is much lower compared to untreated patients of other series. There were no differences between the somatostatin and octreotide group. There were no significant side effects. Gastroscopy at the end of the therapy showed improvement of the endoscopic appearance. CONCLUSIONS: This open study suggests that somatostatin is a safe and effective treatment of acute severe bleeding from portal hypertensive gastropathy.

Ulcerative colitis is as common in Crete as in northern Europe: a 5-year prospective study.

OBJECTIVE: To study the incidence of ulcerative colitis and to analyse the pattern of the disease in the prefecture of Heraklion, Crete. PARTICIPANTS: The population at risk comprised 263,670 inhabitants in the prefecture of Heraklion (2641 km2). The two regional hospitals, five health centres, 109 private family doctors and 145 specialists participated in the study. METHODS: A prospective and population-based epidemiological study of ulcerative colitis over five years from 1990 to the end of 1994. RESULTS: Overall, 117 patients with ulcerative colitis (75 males and 42 females) were newly diagnosed during the study period. The mean annual incidence of the disease for the years 1990-1994 was 8.9 per 10(5) inhabitants (95% CI 7.2-10.4). The male to female ratio was 1.8:1. There were no significant difference between the age-specific incidences of the age groups. The majority (51.3%) of the patients were exsmokers and one-third had never smoked. A family history of first-degree relatives positive for inflammatory bowel disease was obtained in 9.6% of our patients. CONCLUSION: Ulcerative colitis is common in Crete; its incidence is as high as in Northern Europe.

Increased levels of lipoprotein (a) in Crohn's disease: a relation to thrombosis?

OBJECTIVE: Lipoprotein (a) is recognized as a risk factor for arterial and venous thrombosis, a property that might be related to its structural similarity to plasminogen. Since patients with inflammatory bowel disease frequently suffer from thromboembolic events, we studied the role of lipoprotein (a) in conjunction with lipids and apolipoproteins in Greek patients with ulcerative colitis and Crohn's disease. METHODS: Lipoprotein (a), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, apolipoprotein A-1 and apolipoprotein B-100 were determined in sera from 129 consecutive fasting Greek patients with inflammatory bowel disease (66 with ulcerative colitis and 63 with Crohn's disease) and from 66 matched healthy controls. RESULTS: In Crohn's disease patients, the mean serum lipoprotein (a) level was significantly higher than in control patients (41.2 mg/dl vs 22.9 mg/dl; P = 0.005). Mean apolipoprotein A-1 and apolipoprotein B-100 levels were significantly lower in Crohn's disease patients than in the controls. In ulcerative colitis patients the mean levels of lipoprotein (a) and apolipoprotein A-1 were not significantly different to the controls, but the levels of apolipoprotein B-100 were significantly lower. Raised levels of lipoprotein (a) of > 30 mg/dl were found in 29 Crohn's disease patients (46%), 15 ulcerative colitis patients (23%) and 11 control patients (17%). Patients with active Crohn's disease had significantly higher mean lipoprotein (a) and lower apolipoprotein A-1 than patients with non-active disease. CONCLUSIONS: Our results suggest that Crohn's disease patients have different lipoprotein (a) and apolipoprotein patterns compared to ulcerative colitis patients and healthy controls. These changes in Crohn's disease patients may possibly expose them to a higher risk of thrombosis.

Association between ulcerative colitis and systemic lupus erythematosus: report of two cases.

BACKGROUND: Common aetiopathogenic factors may explain the association of ulcerative colitis with autoimmune disorders such as systemic lupus erythematosus. PATIENTS: We report two cases of ulcerative colitis associated with idiopathic systemic lupus erythematosus: one patient who developed ulcerative colitis 11 years after having been diagnosed as a case of systemic lupus erythematosus and one case of simultaneous appearance of the two diseases. The lupus clinical manifestations were in neither case correlated with the treatment of ulcerative colitis. CONCLUSION: The association between ulcerative colitis and systemic lupus erythematosus is rare. Although a chance occurrence cannot be excluded it is possible that both conditions share some genetic or immunological defects.

Natural history of advanced hepatocellular carcinoma in Crete. Association with hepatitis C virus.

OBJECTIVE: To investigate the clinical characteristics of advanced hepatocellular carcinoma (HCC) in Crete and to analyse the natural course of the untreated disease. PARTICIPANTS: Seventy-three patients (62 men) were enrolled in a prospective 4-year study. Clinical and virological parameters were recorded. Diagnosis was based on either ultrasound guided liver biopsy or a pathognomonic increase in alpha-fetoprotein plus compatible imaging. METHODS: Statistical analysis was performed using histograms, contingency tables and one-way analyses of variance to analyse the characteristics of the disease. For survival analysis Kaplan-Meier survival curves and Cox's proportional hazards models were constructed. RESULTS: HCC in Crete is a mostly male disease (7:1 male:female ratio) and unlike in mainland Greece, it is mostly a hepatitis C virus (HCV)-related disease (54% HCV positive as opposed to only 13% in mainland Greece). Prognosis was associated with Okuda classification (Okuda stage III patients have a relative risk of dying that is seven to nine times higher than for Okuda stage I), the presence or absence of hepatitis Be antigen (HBeAg) and antibody to hepatitis B core antigen (anti-HBc). By contrast the presence of anti-HCV was not associated with a worse prognosis. A unit increase of albumin concentration was associated with an 11% decrease in the hazard rate. CONCLUSION: In general, Crete, despite the extremely similar population to the rest of Greece, resembles more closely the situation in Spain or Italy rather than mainland Greece.

Lung function in patients with inflammatory bowel disease.

Previous studies on baseline pulmonary function testing (PFT) abnormalities in patients with inflammatory bowel disease (IBD) are conflicting because most of them have incorporated patients suffering from both ulcerative colitis (UC) and Crohn's disease (CD). The aim of the study is to investigate whether any PFT abnormalities could be detected in a large group of IBD patients and whether there are differences between the two IBD entities. A total of 132 patients, 47 with CD (mean age 35 years) and 85 with UC (mean age 40 years) were studied. Pulmonary function tests (PFTs), lung transfer factor for carbon monoxide (TLCO) were examined and compared with those of 36 healthy controls. No significant difference of mean values of spirometric indices, TLCO and ABG was found between the two groups of patients and controls, or between patients with CD and UC. However, nine (19%) patients with CD and 15 (17.6%) with UC had a reduction in TLCO, a percentage significantly higher than in controls (P < 0.05). The majority of the patients with TLCO reduction were in an active phase of disease (P < 0.05). Our results suggest that there is no difference in routine PFTs between UC and CD patients, as well as between both these groups and normal controls. However, TLCO abnormalities related to the degree of disease activity are found in patients with both UC and CD.

The macronutrient composition of the Greek diet: estimates derived from six case-control studies.

Nutritional data concerning the comparison (control) series of six case-control studies undertaken in the 1980s in Athens were used to estimate the percent energy intake from major macronutrient groups in the contemporary Greek diet. The data were generated by interviewer-administered semi-quantitative food frequency questionnaires in the context of studies probing the nutritional aetiology of several chronic diseases. The analyses were eventually based on 228 men and 610 women 40-79 years old. The main results were as follows: (i) age has very little effect on the proportion of energy intake from the macronutrients studied, although a declining trend is evident with respect to total energy intake; (ii) the proportion of energy intake from saturated fat and monounsaturated fat and, accordingly, total fat is higher among women than among men; (iii) in the Athenian (urban) Greek population in the 1980s, the proportion of energy derived from proteins is about 19%, from carbohydrates is about 37% and from fats is about 44%; and (iv) the P/S ratio is approximately 1:4 whereas the M/S ratio is approximately 1:1, although the latter ratio may be underestimated. It is concluded that low total fat intake is not a characteristic of the Greek diet and cannot explain the apparently health-promoting consequences of this diet.

Environmental risk factors in inflammatory bowel disease.

Besides a genetic predisposition, a causal role of various environmental factors have been taken into consideration in the etiology of inflammatory bowel disease (IBD). The most consistent association of environmental factors so far identified is the association between non smoking and ulcerative colitis (UC) as well a between smoking and Crohn's disease (CD). Other factors such as oral contraceptives, refined sugar, perinatal events, childhood infections, microbial agents, and domestic hygiene have been found to be associated with ulcerative colitis and Crohn's disease but further evaluation is required to confirm the consistency and to define the strength of the association. Recent data also suggest that measles virus may persist in intestinal tissue and early exposure to the virus may be a risk factor for development of CD. The further investigation of environmental factors on IBD and the explanation of their role is expected to open new avenues for basic scientific research and may lead to the development of a more rational approach to the prevention and treatment of IBD. The available data suggest that UC and CD are heterogeneous disorders of multifactorial etiology in which hereditary and environmental factors interact to produce the disease.

A double-blind study of cimetidine in patients with duodenal or gastric ulcer in Greece.

The results of a double-blind study comparing oral cimetidine with placebo in the short-term treatment of endoscopically proven gastric and duodenal ulceration are presented. Cimetidine was used at a dosage of one gram per day and treatment continued over a period of 4 weeks. Greek patients' tolerance of the drug has been recorded. The outcome of treatment was significantly better for the group of patients who received cimetidine treatment.

Ulcerative colitis in Greece. Epidemiologic and clinical data.

Epidemiologic and clinical observations were made in 217 cases of ulcerative colitis between 1977 and 1983 in Evangelismos Hospital, Athens, Greece. The disease affected both sexes equally. The peak incidence occurred between 21 and 30 years of age. A second peak concerning only men was observed in the 6th decade of life. Urban and highly educated sections of the population were more often affected. Severe attacks were seen in only 3.4% of the patients at onset of the disease. Surgical treatment (colectomy) was applied to one in every seven patients either for a severe attack or on suspicion of cancer or debilitating symptoms.

Disturbance of cell-mediated immunity in patients with carcinoma of colon and rectum.

The cellular immune mechanisms of patients with adenocarcinoma of colon or rectum were evaluated by studying the lymphocyte response to PHA stimulation. Our results indicate that the serum of cancer patients causes a decreased blastic transformation and H(3) thymidine uptake of the lymphocytes of patients as well as of normal controls. A defect of the lymphocytes unrelated to serum factors was also present in some cancer patients. However, no relationship was found between the degree of transformation and the presence of metastases in the lymph nodes.