Vertebra prominence in women: significance in clinical practice and in surface topography.

A sexual dimorphism (SD) of the "vertebra prominens" was found, namely the 7th cervical vertebra (C7) spinous process (SP) is more frequently longer in men and the 1st thoracic (T1) SP in women.[1] We assume that the cause of this SD is the different anatomy of the anterior upper thoracic region (AUTR) between men and women, due to the presence of the breast. One-hundred forty-two women aged 48.1Âs17 years old, who visited the OPD for neck complaints, were studied. Measures included the age, the relationship of C7 and T1 SP length, documented in three types (type 1= [C7>T1], 2 = [C7 = T1], 3 = [C7 < T1]), the breast size, (small, medium and large), the length ratio of C7/T1 SP and the BMI. Breast size and SP length relationship between C7 and T1 was found to be significantly correlated. The results confirm that the cause of the SD of the SP length of C7 and T1 seems to be the different female AUTR anatomy due to the presence of the breast and it is probably the result of the need of the posterior cervical anatomical structures to compensate for the higher torque created by the female AUTR anatomy. These original findings are useful in clinical examination, in breast oncology, for the plastic surgeons, in terms of implantation of the proper breast size implant, after mastectomies for malignancies but also for aesthetic reasons and the software of all surface topography devices should be adjusted accordingly.

Radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery. Mid-term results.

BACKGROUND: Atrial fibrillation is found in an increasing number of patients undergoing open heart surgery. It is associated with higher mortality rates, risk of stroke and left ventricular dysfunction. Surgical ablation for atrial fibrillation has evolved from the complex"cut and sew" Maze procedure to less invasive techniques, utilizing alternative energy sources. We present our experience with left atrial radiofrequency ablation during cardiac surgery, outlining the technical aspects of the procedure and postoperative outcomes, with emphasis on mid-term freedom from atrial fibrillation. METHODS: The study included 93 consecutive patients with history of atrial fibrillation scheduled for cardiac surgery between January 2008 and December 2011. Concomitant left atrial radiofrequency ablation was performed using monopolar (endocardial) or bipolar (epicardial) systems, depending on the type of underlying cardiac pathology. Duration of the atrial fibrillation, re-do surgery, low ejection fraction, advanced age, or giant left atria were not considered as contraindications. RESULTS: Of the included patients, 73.1 % were discharged in stable sinus rhythm. Overall freedom from atrial fibrillation was 69.6 % at late follow-up, which ranged from 12 to 48 months (median, 22 months) and did not differ for the two approaches (epicardial vs. endocardial). The presence of early atrial tachyarrhythmia was a predictor of atrial fibrillation recurrence (p = 0.026). Age was also associated with higher recurrence rates during hospital stay (p = 0.04), but not for late atrial fibrillation. CONCLUSION: Concomitant left atrial radiofrequency ablation conveyed satisfactory early and mid-term rhythm control, with acceptable postoperative outcomes, given the risk profile of our patient cohort.

The three-surgeon technique for liver tissue dissection: towards real bloodless hepatectomy.

PURPOSE: Bleeding during hepatectomy remains a major cause of mortality despite recent developments in surgical and anaesthetic techniques. To date there is no single surgical device that combines speed, efficient haemostasis and safety for the adjacent vital structures during parenchymal division. This article presents the Three Surgeon Technique (3ST), a novel method of parenchymal dissection for major hepatectomies and compare it with our standard radiofrequency ablation (RFA) - assisted technique. METHODS: 77 patients who underwent major liver resection were divided into two groups: 38 of them (group A) underwent 41 RFA-assisted liver resections and 39 (group B) underwent 41 hepatectomies with the 3ST. The data for the 3ST were prospectively collected and compared to the already collated RFA patient group. RESULTS: Blood transfusion was necessary in 28 and 13 patients in group A and B respectively (p=0.016), with an average of 1.7 and 0.6 units of red blood cells (p<0.001). The Pringle maneuver was not required with the 3ST. The mean time of parenchymal dissection was 90.49 and 77.52 min in group A and B, respectively (p=0.007). CONCLUSION: The 3ST is a novel, reliable and safe alternative to the stand alone RFA-assisted technique. It is a faster procedure, and requires less blood units transfusion.

The diverse associations of uric acid with low-grade inflammation, adiponectin and arterial stiffness in never-treated hypertensives.

The data regarding the role of serum uric acid (SUA) along with subclinical inflammation in the context of hypertensive vascular damage are rather scarce and controversial. Towards this end, we assess the links between SUA, high-sensitivity CRP (hs-CRP), adiponectin and carotid to femoral pulse wave velocity (c-f PWV) in 292 subjects with never-treated stage I-II essential hypertension. On the basis of the median SUA levels (0.31 mmol l(-1)), the study population was divided into subjects with low (n=149) and high (n=143) SUA values. By multiple regression analysis, it was revealed that SUA was independently associated with log hs-CRP (R(2)=0.098; P=0.02), log adiponectin (R(2)=0.102; P=0.03), waist circumference (R(2)=0.049; P=0.04), 24-h systolic blood pressure (SBP) (R(2)=0.179; P=0.001) and estimated glomerular filtration rate (R(2)=0.156; ß (s.e.)=-0.169 (0.023); P=0.02). In addition, c-f PWV was independently associated with age (R(2)=0.116; P<0.0001), waist circumference (R(2)=0.088; P<0.0001), 24-h SBP (R(2)=0.167; P=0.001), log adiponectin (R(2)=0.07; P=0.006) and log hs-CRP (R(2)=0.06; P=0.034). In conclusion, SUA levels are independently associated with hs-CRP and adiponectin levels but not with c-f PWV in essential hypertensive patients. Increased SUA levels are accompanied by a state of pronounced inflammatory activation and hypoadiponectinemia that significantly impairs the arterial stiffness accelerating the vascular ageing process in this setting.

Predictive value of complete and partial early virological response on sustained virological response rates of genotype-4 chronic hepatitis C patients treated with PEG-interferon plus ribavirin.

OBJECTIVES: To investigate early viral kinetics, sustained virological response (SVR) rates and their predictors, in treatment-naïve, genotype-4-infected, chronic hepatitis C (CHC) patients treated with PEG-IFNalpha2b plus ribavirin. PATIENTS AND METHODS: In total, 58 patients were retrospectively analyzed. Early virological response (EVR) was defined as undetectable HCV-RNA (<50 IU/ml) at week 12 (complete, cEVR) or at least a 2 log decrease in HCV-RNA levels (partial, pEVR). RESULTS: Thirty-one patients exhibited SVR (53.4%), 17 (29.3%) were non-responders and 10 (17.2%) relapsed. Thirty-seven patients (63.8%) exhibited EVR. The positive predictive values of EVR, cEVR and pEVR for the SVR achievement were 83.87, 54.83, and 29.03%, whereas their negative predictive values were 59.25, 77.77, and 81.48%, respectively. Both cEVR (OR 0.040, p = 0.042) and EVR (OR 0.016, p = 0.006) independently predicted SVR. Baseline viral load (p < 0.001), age (p = 0.035) and stage of liver disease (p = 0.04) were significantly related to the EVR achievement, whereas only baseline viral load (p = 0.003) and ethnicity (p = 0.025) predicted cEVR. CONCLUSIONS: Partial or complete EVR represent independent predictors of SVR in genotype-4-infected CHC patients, regardless of their baseline parameters. The absence of pEVR, rather than the absence of cEVR, should be used as an early indication for discontinuation of treatment in these patients.

Family correlates of adolescents' emotional/behavioural problems: evidence from a Greek school-based sample.

AIM: To investigate the associations of some family characteristics with adolescents' self-reported emotional/behavioural problems. METHODS: Questionnaires were administered to a Greek nation-wide random sample of adolescents (N = 1194) aged 11-18 years and their parents (N = 973) in 2003. The present analysis included the questionnaires completed by mothers and their offspring (639 families). Adolescents' emotional/behavioural problems, as measured by the Strengths and Difficulties Questionnaire, were assessed in relation to family socioeconomic status and residence type, parental marital status, educational attainment and subjective mental health, family cohesion and parent-child relations. RESULTS: The analysis showed that parental marital status other than being married, poor parent-child relations and low levels of maternal subjective mental health were independently correlated with significantly more adolescents' emotional/behavioural problems. CONCLUSION: Family factors are potential determinants of adolescent emotional/behavioural problems and therefore are potential targets for prevention and/or intervention.

Differential viral kinetics in treated genotype 4 chronic hepatitis C patients according to ethnicity.

Data concerning the efficacy of PEG-IFN alpha 2a plus ribavirin treatment in treatment-naive, genotype 4-infected chronic hepatitis C (CHC) patients from Europe are limited. Hence the aim of this study was to investigate the viral kinetics as well as the sustained virological response (SVR) rates and their predictors, in these patients. One hundred and twenty-three patients were retrospectively analysed. Early (EVR) and late virological response (LVR) was confirmed by undetectable (<50 IU/mL) serum HCV-RNA at week 12 and week 24 of treatment, respectively. SVR was confirmed by undetectable serum HCV-RNA at the end of treatment as well as 6 months later. Overall, 43.5% of patients exhibited SVR, 42.6% were nonresponders and 13.9% were relapsers. EVR was observed in 40.74% and LVR in 59.25% of them. The positive predictive values of EVR and LVR were 72.97% and 86.27% whereas their negative predictive values were 64.29% and 92.85%, respectively. EVR independently predicted SVR in Caucasian patients (P < 0.001) but not in Egyptian patients (P = 0.613), in whom the only independent predictor of SVR was the absence of cirrhosis (P = 0.004). LVR seems to be a better predictor of SVR than EVR in the vast majority of genotype 4-infected CHC patients, irrespective of ethnicity and all the other baseline parameters.

Adolescent smoking and health-related behaviours: interrelations in a Greek school-based sample.

BACKGROUND: Although several studies have reported findings concerning the interrelationship between smoking and specific health behaviours, little research has investigated how smoking behaviour may be associated with a cluster of health-related behaviours. The present study was an effort to extend previous research through assessing smoking status, patterns of physical and sedentary activity, as well as eating behaviours and diet quality, in order to gain some insight regarding the relationship between cigarette smoking and a cluster of health behaviours in a Greek sample of adolescents. METHODS: A sample of 2008 students (1021 male and 987 female, 12-17 years of age, 7th-12th grade) was selected from all schools of a representative Athens suburb in Greece. All children completed a questionnaire that was developed for the purposes of the study which retrieved information about age, sex, school class, individual and family smoking status, dietary habits and physical activity. Various statistical tests were performed. RESULTS: Age, playtime, consumption of soft drinks and foods from school canteens were positively associated with smoking status while the consumption of fruit juice, dairy products for breakfast and the frequency of breakfasts were inversely associated the aforementioned dependent variable. CONCLUSIONS: This study supports the interrelationships between multiple lifestyle behaviours and tobacco use in adolescents. Future research is needed in order to elaborate on the nature of these relations, especially for those at higher risk.

Association of dehydroepiandrosterone-sulfate with endothelial function in young women with polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to assess non-invasively endothelial function of young women with polycystic ovary syndrome (PCOS) in comparison with healthy age-matched women and a group of young women with idiopathic hirsutism (IH). The possible role of metabolic and hormonal parameters on endothelial function was also examined. DESIGN: Descriptive clinical trial. METHODS: Fifty-six women, 27 with PCOS, 16 with IH and 13 healthy age-matched women were studied. Endothelial function of resistance arteries was assessed by venous occlusion plethysmography. Metabolic and hormonal parameters were estimated in this study population. RESULTS: The duration of reactive hyperemia (durRH) was shorter in PCOS group when compared with normal controls (63.75 +/- 13.33 s vs 113.18 +/- 20.92 s, P = 0.036). A similar finding was observed when PCOS were compared with IH group (63.75 +/- 13.33 s vs 105 +/- 17.20 s, P = 0.05). The durRH did not differ between IH and control group (105 +/- 17.20 s vs 113.18 +/- 20.92 s, ns). A significant positive linear correlation was found between the durRH and dehydroepiandrosterone-sulfate (DHEA-S) levels (r = +0.48, P = 0.04) in the PCOS group. The basal insulin resistance index (HOMA) differed significantly between PCOS, IH and control groups. There was no significant correlation between durRH and HOMA index or testosterone levels in the PCOS group. CONCLUSIONS: Endothelial dysfunction may be an early sign of cardiovascular system abnormalities in young PCOS women. It is possible that increased DHEA-S levels may offer a cardioprotective advantage that attenuates the effects of cardiovascular risk factors that accompany PCOS.

Interferences of o-raffinose cross-linked hemoglobin in three methods for serum creatinine.

The interferences of o-raffinose cross-linked hemoglobin (Hemolink) were examined and compared in two serum creatinine methods on the Hitachi 717 [Boehringer Mannheim (BMC) and Synermed] and in an enzymatic creatinine method on the Vitros 750 (Johnson & Johnson). Interference was considered significant when the change in creatinine concentration from the control exceeded the 95% confidence limits of each method. Significant interference was observed for the BMC/Hitachi 717 method with Hemolink > or = 5 g/L. No interference was observed for the Synermed/Hitachi 717 assay with Hemolink up to 30 g/L in normal samples and up to 50 g/L in samples with increased creatinine. No interference was observed for the Vitros 750 assay with Hemolink up to 50 g/L at both normal and increased concentrations of creatinine. Although the BMC/Hitachi 717 method was considered unacceptable, the Synermed/Hitachi 717 and the Vitros 750 methods allow accurate quantification of serum creatinine in the presence of Hemolink.