Laparoscopic treatment of 1522 adnexal masses: an 8-year experience.

Objective. To reevaluate the long-term effectiveness and safety of laparoscopy in benign ovarian pathology. Materials and Methods. 1522 women with benign adnexal cysts, laparoscopically treated in the 3rd Department of Ob/Gyn, General University hospital "Attikon" and "Lito" Maternity Hospital between July 1998 and December 2006, were included. Results. The diagnosis in 1222 (80,6%) cases was endometriosis of the ovary, 60 (4%) hydrosalpinx, 51 (3,3%) serous cystadenomas, 44 (2,9%) dermoid ovarian cyst, 38 (2,5%) borderline tumors, 35 (2,3%) unruptured follicles, and 33 (2,2%) paraovarian cysts. In 174 cases (11,5%) laparoscopy was converted to laparotomy due to technical difficulties or suspicion of cancer. In particular, laparotomy was performed in 119 (8%) women due to severe adhesions and 18 (1,2%) women due to bleeding that could not be controlled safely by laparoscopy. In 36 (2,4%) women frozen section during operation revealed malignancy and laparoscopy was converted to laparotomy. A few operative complications were recorded like post-op fever, small hematomas at the trocar entries. Conclusions. Laparoscopic surgery seems to offer significant advantages such as reduced hospital stay, less adverse effects, better quality of life, and superior vision especially on surgical treatment of cases like endometriosis.

Preliminary results of objective assessment of mammographic percent density.

Breast density assessments performed by using the Breast Imaging Reporting and Data System (BI-RADS) have been completely qualitative and the American College of Radiology (ACR) fibroglandular density descriptors are mainly subjective. However, women with increased mammographic density (MD) have an increased risk of developing breast cancer. The purpose of our study was to evaluate an experimental method to quantify MD using a software utility which measures absolutely black areas as zero and absolutely white areas as 100. In grey scale areas, these values range between 0 and 100, depending on the "density" of the area. Digital screening mammograms were directly estimated with this method. We concluded that there is a significant correlation between ACR quartiles and this grey scale percentage method, although several improvements on the original idea are planned.

Air pollution and inflammation in type 2 diabetes: a mechanism for susceptibility.

BACKGROUND: Particulate air pollution has been associated with several adverse cardiovascular health outcomes, and people with diabetes may be especially vulnerable. One potential pathway is inflammation and endothelial dysfunction-processes in which cell adhesion molecules and inflammatory markers play important roles. AIM: To examine whether plasma levels of soluble intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and von Willebrand factor (vWF) were associated with particle exposure in 92 Boston area residents with type 2 diabetes. METHODS: Daily average ambient levels of air pollution (fine particles (PM2.5), black carbon (BC) and sulphates) were measured approximately 500 m from the patient examination site and evaluated for associations with ICAM-1, VCAM-1 and vWF. Linear regressions were fit to plasma levels of ICAM-1, VCAM-1 and vWF, with the particulate pollutant index, apparent temperature, season, age, race, sex, glycosylated haemoglobin, cholesterol, smoking history and body mass index as predictors. RESULTS: Air pollutant exposure measures showed consistently positive point estimates of association with the inflammatory markers. Among participants not taking statins and those with a history of smoking, associations between PM(2.5), BC and VCAM-1 were particularly strong. CONCLUSIONS: These results corroborate evidence suggesting that inflammatory mechanisms may explain the increased risk of air pollution-associated cardiovascular events among those with diabetes.

Disease prevention and preparedness for animal health emergencies in the Middle East.

The animal health situation in the Middle East is particularly unfavourable, as this area is exposed to many serious animal diseases. The Middle East is ill-prepared to institute disease prevention and control measures, due to deficiencies at both national and regional levels. Early detection, diagnosis and reporting of diseases must become a priority within these countries and effective communication should be maintained among them. Regional animal health programmes and the support of international institutions are essential to improve preparedness for natural or human-caused emergency situations, which can seriously affect animal health. Such emergencies can also have significant impacts on related public health issues.

Screening of dogs for Echinococcus granulosus coproantigen in a low endemic situation in Cyprus.

In the framework of an echinococcosis surveillance and control programme in Cyprus, a commercial enzyme-linked immunosorbent assay (ELISA) (CHEKIT ECHINOTEST) designed for the detection of Echinococcus granulosus and E. multilocularis coproantigens was used in 1997-2000 for the investigation of large numbers of dogs. Most of the animals originated from areas where approximately 0.2% of the dogs had been found to be infected with E. granulosus in previous (1993-1996) arecoline surveys. The sensitivity of the coproantigen test was 83%, as determined in 35 dogs naturally infected with this cestode species. The specificity was 98% in 97 randomly selected dogs from Cyprus, but it was reduced to 80% in a group of 50 dogs, infected with Taenia spp. A total of 6551 dogs (mainly of rural origin) was examined, including three large groups (N: 2928, 1761 and 1800) from the Government Control Area (GCA) in southern Cyprus and a small group (N: 62) from the Non-Government Control Area (NonGCA) in the northern part of the island. Among the dogs from the GCA, 184 (2.8%) tested positive for coproantigen; coproantigen prevalences were 2.6, 4.9 and 1.1% in these three groups, and of 62 dogs from the NonGCA 8.1% were positive. The calculated true prevalences of E. granulosus in the dog population of the GCA ranged between 0.0 and 3.58%. The predictive values of the test, based on a 0.2% prevalence, was >99.9% for negative results, but very low (7%) for coproantigen-positive results. However, the relatively small number of coproantigen-positive dogs can be treated with praziquantel or the results can further be confirmed by arecoline purging.

[Phlebotomines of the Isle of Cyprus. III. Species inventory ]. / Les phlébotomes de l'Ile de Chypre. III--Inventaire faunistique.

Three surveys on canine leishmaniasis were carried out in Cyprus (1993, 1998 and 1999) emphasise the presence of eleven species of phlebotomine sandflies: Phlebotomus (Phlebotomus) papatasi, P. (Paraphlebotomus) alexandri, P. (Pa.) jacusieli (first mention in Cyprus), P. (Pa.) sergenti, P. (Larroussius) galilaeus, P. (L.) tobbi, P. (Transphlebotomus) economidesi, P. (T.) mascittii, Sergentomyia (Sergentomyia) azizi (its specific statute is validated by the authors), S. (S.) fallax et S. (S.) minuta. P. (Adlerius) kyreniae was not caught during the surveys. The authors propose hypothesis of settlement of the island by phlebotomine sandflies according this species inventory. A first migration period took probably place during the Miocene time and a second one during the Pleistocene time.

[Phlebotomine sandflies (Diptera-Psychodidae) of the isle of Cyprus. II--Isolation and typing of Leishmania (Leishmania infantum Nicolle, 1908 (zymodeme MON 1) from Phlebotomus (Larroussius) tobbi Adler and Theodor, 1930]. / Les phlébotomes (Diptera-Psychodidae) de l'île de Chypre. II--Présence de Leishmania (Leishmania) infantum Nicolle, 1908 (zymodeme MON1) chez Phlebotomus (Larroussius) tobbi Adler et Theodor, 1930.

During two surveys conducted in Cyprus (August 1998 and September 1999), 2,910 phlebotomine sandflies females were caught by CDC miniature light traps then dissected under binocular and examined on microscope. Eleven species were identified: Phlebotomus papatasi, P. sergenti, P. jacusieli, P. alexandri, P. tobbi, P. galilaeus, P. mascittii, P. economidesi, Sergentomyia fallax, S. minuta et S. azizi. The Larroussius species (P. galilaeus and P. tobbi) are the most abundant (more than 60% of our captures). Promastigotes were isolated from one specimen identified as P. tobbi. A Leishmania stock was successfully cultured and identified by isoenzyme characterisation as belonging to L. infantum zymodeme MON 1. The same zymodeme was isolated and identified from four dogs too. Because of the absence of usual vectors of L. infantum in the eastern part of the Mediterranean basin (P. neglectus and P. syriacus), and according to its distribution in Cyprus, P. tobbi constitute certainly a good local vector. It seems to be not very anthropophilic, that could explain the very few human cases.

Control of zoonoses in Cyprus.

The excellent results achieved in the control of animal diseases in Cyprus have allowed the Veterinary Services to take a leading role in the elimination, surveillance and investigation of important zoonoses. The programmes for the control of echinococcosis, brucellosis, bovine tuberculosis, anthrax and taeniasis, and the measures taken to prevent the importation of rabies are described. Public awareness of the risks posed by the presence of zoonoses and the efficient and effective intersectoral co-operation achieved between the veterinary, medical, public health and other Government services and non-governmental organisations are considered to be the key to the successful control of zoonoses in Cyprus.

Evaluation of control programmes for echinococcosis/hydatidosis in Cyprus.

In Cyprus, echinococcosis (Echinococcus granulosus) was an important public and animal health problem until the 1970s. In 1971, the Department of Veterinary Services instigated a control programme, which was based on an island model, using arecoline testing, euthanasia of positive dogs, control of dog breeding, elimination of stray dogs and control measures in slaughterhouses. The first programme ended in 1985 with excellent results and E. granulosus was considered to have been eradicated from both the definitive hosts (dogs) and the intermediate hosts (livestock). However, surveillance from 1985 to 1993 demonstrated that the life-cycle of E. granulosus was continuing at very low levels. Control measures were therefore reintroduced in 1993. The second programme commenced in 1993 and was based on surveillance of intermediate hosts, control of infected flocks, and testing and treatment of owned and stray dogs in infected areas. A continental model was employed for the second programme, due to the division of the island in 1974. The experience gained from the two programme is described.

Assessment of physician responses to abnormal results of bone densitometry studies.

OBJECTIVE: To assess how physicians who have ordered bone densitometry studies respond to abnormal results. METHODS: We conducted a retrospective review of cases from physicians affiliated with a community teaching hospital. The study sample consisted of 142 female patients with abnormal bone mineral density (BMD) who had been referred by 50 physicians (internists or gynecologists). A questionnaire was completed for each patient, providing data about further investigations, treatment interventions, and frequency of referral to a specialist in bone diseases. RESULTS: Of the patients diagnosed with osteoporosis on the basis of BMD studies, 20.4% had no further investigations, and 27.8% underwent only mammography. Of all the patients with osteoporosis, 10.6% received no therapy (calcium and vitamin D excluded). The majority of all patients (71.8%) received a combination of calcium and vitamin D. The most common treatment modality was hormone replacement therapy. The second most common treatment strategy was bisphosphonates. The percentage of all referrals to specialists in metabolic bone diseases was low--11.3% in the patients of internists and 14.5% in the patients of gynecologists. CONCLUSION: In this study, the information provided by bone densitometry did not affect management in a substantial percentage of patients. A considerable percentage of patients underwent no further investigations to rule out secondary causes of osteoporosis.

Canine leishmaniosis in Cyprus due to Leishmania infantum MON 1.

During a serological survey in 1996, a total of 601 dogs (group I) distributed all over the government controlled southern area of Cyprus was examined using an enzyme-linked immunosorbent assay (ELISA) for the presence of specific antibodies directed against soluble antigens of promastigote stages of Leishmania infantum. The overall seroprevalence rate in this group was 1.7%. A second group (group II) of dogs was selected from regions where seropositive dogs where determined within the first group. In group II specific anti-Leishmania antibodies could be detected in 30 of 301 dogs investigated (10%). The highest seroprevalence rates were found in the regions of Agios Georgios (26.2%) and Limnatis (12.2%). Ten parasite isolates from ten dogs (six with typical symptoms of canine leishmaniosis and four without symptoms) originating from five locations could be characterised by zymodeme analysis. All ten isolates were identified as L. infantum zymodeme MON 1.

Control of Echinococcus granulosus in Cyprus and comparison with other island models.

A control programme directed against Echinococcus granulosus was introduced into the Republic of Cyprus in 1971. In 1974, this was restricted to the areas controlled by the government of the island. The force used in the 'attack' phase included a major dog control programme. This and other measures led to the rapid 'disappearance' of the parasite and control was terminated in 1985. Subsequent studies during 1993-1996 revealed that the parasite was present in 82 (20%) villages in either dogs or food animals or both and control was re-introduced in the 'consolidation' phase with emphasis on the surveillance of E. granulosus in intermediate hosts, animal movement control and treatment of dogs in 'infected' villages. During these surveys, a major difficulty was found to be in determining whether transmission was autocthonus or introduced by animals from the areas not controlled by the government. Evidence was found to suggest the former was the most likely for the infected animals which had been born and reared far from the dividing line in the government-controlled area. A major contribution of this and other island programmes, such as those in Iceland, New Zealand, Tasmania (Australia) and the Falkland Islands, to an understanding of control planning has been the demonstration that it cannot readily be determined when eradication has been achieved and that once the costly 'attack' phase has been converted into the much more cost-effective 'consolidation' phase this must be maintained indefinitely in that phase if there is cross-border transmission as is likely to be the case in all Continental control programmes.

The role of endothelial function on the foot. Microcirculation and wound healing in patients with diabetes.

Wound healing is defective in patients with diabetes, which may be attributed to many factors. Our data indicate that impairment of the microcirculation is a major factor. Although the exact causes of microvascular impairment are not known, dysfunction of the endothelium has emerged over the last decade as the prominent abnormality related to vascular disease in diabetes. Further studies are required to clarify the causes of endothelial dysfunction and identify potential therapeutic interventions in the future.