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Giouleme O, Paschos P, Katsoula A, Panteliadou K, Vakalopoulou S, Garipidou V. Hepatitis C infection in a Greek population with inherited bleeding disorders. Haemophilia 2018; 24:e74-e76. [DOI: 10.1111/hae.13427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 01/01/2023]
Affiliation(s)
- O. Giouleme
- Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki Greece
| | - P. Paschos
- Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki Greece
| | - A. Katsoula
- Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki Greece
| | - K. Panteliadou
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki Greece
| | - S. Vakalopoulou
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki Greece
| | - V. Garipidou
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki Greece
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Andreadis P, Kafantari K, Agapidou A, Vakalopoulou S, Vlachaki E. Successful Outcome of Severe Intra-cerebral Bleeding Associated with Acquired Factor V Inhibition: Utilization of Multiple Therapeutic Agents. Balkan Med J 2018; 35:112-115. [PMID: 28903884 PMCID: PMC5820439 DOI: 10.4274/balkanmedj.2017.0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Acquired coagulation factor inhibitors are antibodies that either inhibit activity or increase the clearance of a clotting factor and lead to an increased risk of bleeding. Most of the time, the disorder is attributed to factor VIII inhibition (acquired haemophilia A); however, other coagulation factors could also be implicated. Case Report: Herein, we report an interesting case of a patient who underwent coronary artery bypass grafting and received antibiotic treatment after surgery with third generation cephalosporin. A month later, he presented with extreme bleeding diathesis and cerebral haemorrhage. Following a thorough clinical and laboratory investigation, an acquired factor V inhibitor was diagnosed. The patient received treatment with corticosteroids, intravenous immunoglobulins, anti-CD20 monoclonal antibodies (rituximab), cyclophosphamide and recombinant factor VIIa. Finally, despite the poor initial prognosis, the patient managed to achieve a full recovery. Conclusion: As there are no clear guidelines on acquired coagulation inhibitor treatment, reports of such cases could offer insight for future therapy choices. The case was unique because the treatment regimen included a combination of multiple therapeutic agents including rituximab.
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Affiliation(s)
- Panagiotis Andreadis
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Katerina Kafantari
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Aleka Agapidou
- Clinic of Hematology, Homerton University Hospital, Homerton Row, London
| | - Sofia Vakalopoulou
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Clinic of Internal Medicine, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
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Vyzantiadis TA, Charizopoulou M, Adamidou F, Karras S, Goulis D, Karagiannis A, Garipidou V, Vakalopoulou S, Anagnostis P. The effect of monthly ibandronate on bone mineral density and bone turnover markers in patients with haemophilia A and B and increased risk for fracture. Thromb Haemost 2017; 110:257-63. [DOI: 10.1160/th13-01-0030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/30/2013] [Indexed: 12/23/2022]
Abstract
SummaryHaemophilia A and B have been associated with increased prevalence of low bone mineral density (BMD). However, no study has so far evaluated the effects of anti-osteoporotic therapy on BMD in haemophilia. The primary endpoint of this prospective study was to estimate the effect of 12-month therapy of oral ibandronate 150 mg/ month on BMD in patients with haemophilia A and B. Secondary endpoint was its effect on turnover markers (BTM) of bone resorption [serum C-terminal telopeptide of type 1 collagen (sCTX), tartrate-resistant acid phosphatase band 5b] and bone formation (osteocalcin and bone-specific alkaline phosphatase. Ten adult patients with T-score < −2.5 SD or Z-score < −2 and/or increased risk of fracture according to FRAX model were included. All received 1,000 mg/day calcium carbonate with 800 IU/d cholecalciferol. Males with haemophilia A (n=7) or B (n=3) (mean age 43.5 ± 13.5 years) were studied. Ibandronate resulted in an increase in lumbar BMD (from 0.886 ± 0.169 to 0.927 ± 0.176 g/cm2, 4.7%, p=0.004). No change in BMD of total hip (from 0.717 ± 0.128 to 0.729 ± 0.153 g/cm2, p=0.963) or femoral neck (0.741 ± 0.135 to 0.761 ± 0.146 g/cm2, p=0.952) was noticed. Ibandronate led to a decrease in sCTX (from 0.520 ± 0.243 to 0.347 ± 0.230 ng/ml, −29.9%, p=0.042). No change was observed in other BTM. Ibandronate was generally well-tolerated. In conclusion, ibandronate significantly improved BMD in lumbar spine and reduced bone resorption in adults with haemophilia at increased risk of fracture. Its effect on hip BMD and bone formation markers was not significant.
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Anagnostis P, Vakalopoulou S, Christoulas D, Paschou SA, Papatheodorou A, Garipidou V, Kokkoris P, Terpos E. The role of sclerostin/dickkopf-1 and receptor activator of nuclear factor kB ligand/osteoprotegerin signalling pathways in the development of osteoporosis in patients with haemophilia A and B: A cross-sectional study. Haemophilia 2017; 24:316-322. [PMID: 29194852 DOI: 10.1111/hae.13384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/19/2022]
Abstract
AIM Haemophilia A and B are associated with reduced bone mineral density (BMD). The aim of this study was to assess circulating sclerostin and dickkopf-1 (Dkk-1), (inhibitors of osteoblastic differentiation), as well as the receptor activator of nuclear factor kB ligand (RANKL)/osteoprotegerin (OPG) system (the major regulator of osteoclastogenesis), in patients with haemophilia (PWH), their possible correlations with clinical risk factors and the effect of ibandronate on these markers. METHODS Eighty-nine male PWH (mean age 45.9 ± 15.3 years) and 30 age-matched healthy male controls participated. BMD was assessed by DXA. Sclerostin, Dkk-1, RANKL and OPG were measured in serum of patients, controls, as well as in ten patients receiving oral ibandronate (150 mg/mo), at baseline and after 12 months. RESULTS Patients with haemophilia had lower circulating sclerostin (median ± IQR: 47.4 ± 26.93 vs 250 ± 250 pmol/L, P < .001), Dkk-1 (21.24 ± 17.18 vs 26.16 ± 15.32pg/mL, P = .04) and higher levels of RANKL (0.23 ± 0.03 vs 0.04 ± 0.03 pmol/L, P = .001), RANKL/OPG ratio (0.063 ± 0.25 vs 0.005 ± 0.11, P = .001) compared with controls. Patients with low BMD had higher OPG concentrations compared to those with normal BMD. Sclerostin and RANKL/OPG correlated positively with BMD. Patients with severe haemophilia had lower sclerostin concentrations compared with those with mild or moderate disease. The degree of arthropathy negatively correlated with sclerostin and Dkk-1 levels. PWH who received ibandronate showed a decrease in serum Dkk-1 without any significant effect on sclerostin and RANKL/OPG. CONCLUSIONS Patients with haemophilia present increased osteoclastic activity coupled with compensatory increased osteoblastic activity. Ibandronate did not affect RANKL/OPG ratio, but it decreased Dkk-1.
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Affiliation(s)
- P Anagnostis
- Haemophilia Centre of Northern Greece, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Vakalopoulou
- Haemophilia Centre of Northern Greece, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Christoulas
- Department of Haematology, 251 General Air Force Hospital, Athens, Greece
| | - S A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Papatheodorou
- Department of Haematology, 251 General Air Force Hospital, Athens, Greece
| | - V Garipidou
- Haemophilia Centre of Northern Greece, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Kokkoris
- Department of Endocrinology, 251 General Air Force Hospital, Athens, Greece
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Apostolou C, Klonizakis P, Mainou M, Kapsali E, Kafantari K, Kotsiafti A, Vetsiou E, Vakalopoulou S, Vlachaki E. Rivaroxaban Use in Patients with Hemoglobinopathies. Hemoglobin 2017; 41:223-224. [DOI: 10.1080/03630269.2017.1374969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Chrysoula Apostolou
- Adult Thalassemia Unit, Second Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Philippos Klonizakis
- Adult Thalassemia Unit, Second Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Maria Mainou
- Adult Thalassemia Unit, Second Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Eleni Kapsali
- Department of Hematology, University of Ioannina Medical School, Ioannina, Greece
| | - Katerina Kafantari
- Adult Thalassemia Unit, Second Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Aggeliki Kotsiafti
- Adult Thalassemia Unit, Second Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Evaggelia Vetsiou
- Adult Thalassemia Unit, Second Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Sofia Vakalopoulou
- Hemostasis Laboratory, Second Propedeutic Department of Internal Medicine, Aristotle University, Hippokrateon Hospital, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Adult Thalassemia Unit, Second Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
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Petrakis G, Kostopoulos I, Venizelos I, Lambropoulou M, Vouras K, Vakalopoulou S, Mandala E, Tsatalas C, Papadopoulos N. Expression of the activation markers Blimp1, Foxp1 and pStat3 in extranodal diffuse large B-cell lymphomas. Histol Histopathol 2016; 32:825-834. [PMID: 27924626 DOI: 10.14670/hh-11-852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Different studies have suggested that the expression of biomarkers related to lymphoid cell activation may provide information on the behavior of DLBCL. Most studies have concentrated on nodal or a mixture of nodal and extranodal lymphomas. The differential expression and potential clinical impact of these markers in a homogeneous group of extranodal DLBCLs are not well defined. In this study, we investigated the expression of three activation markers, Blimp1, Foxp1 and pStat3, in a cohort of 35 extranodal DLBCLs homogeneously treated with R-CHOP. Immunohistochemical stains were evaluated using an immunoreactivity score on representative paraffin sections. Blimp1 was positive in 55% (19/35), Foxp1 in 60% (21/35), and pStat3 in 69% (24/35) of our cases. We did not observe any statistical differences in the expression of these markers in GCB and non-GCB tumors or in gastrointestinal and non-gastrointestinal tumors. Blimp1 expression was negatively correlated with overall survival (OS) (p=0.001) in the whole series and in the non-GCB group (Muris algorithm) (p=0.002). Foxp1 positivity and pStat3 positivity had no impact on the outcome of the patients in the global cohort, but they were associated with a better survival in the non-GCB subgroup (p=0.033, p=0.044 respectively). Multivariate analysis showed that Blimp1 expression but not COO was an independent negative prognostic factor for OS (HR=17.5, 95%, CI=2.2-141.1, p=0.007). Our results suggest that these markers are differentially expressed and have different impacts on outcome in extranodal DLBCLs compared to nodal tumors, emphasizing the need to evaluate separately these and probably other markers in these subsets of tumors.
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Affiliation(s)
- Georgios Petrakis
- Histology - Embryology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. .,Pathology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kostopoulos
- Pathology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Venizelos
- Pathology Department of Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Lambropoulou
- Histology - Embryology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kyriakos Vouras
- School of Mathematics, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Vakalopoulou
- Hematology Department, Hippokration Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eudokia Mandala
- Fourth Department of Medicine, Hippokration Hospital of Thessaloniki, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Constantinos Tsatalas
- Hematology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nicolas Papadopoulos
- Histology - Embryology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Abstract
The combination of acute leukemia and pregnancy is infrequent. It is estimated to occur in less than 1 in 75,000 pregnancies. Maternal and fetal outcomes have improved substantially in recent years. In general, multi-agent chemotherapy is given as soon as the diagnosis of leukemia is established, even if it is in the first trimester. There are two important considerations in the management of a patient with leukemia during pregnancy, the mother who needs optimal cancer therapy and the developing fetus who could potentially be affected by the disease and/or the teratogenicity of antineoplactic agents. Vaginal delivery is preferable, and caesarian section is reserved for obstetrical indications only.
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Affiliation(s)
| | | | | | | | - V. Garipidou
- 2nd Internal Medicine Department Hippokratio General Hospital, Thessaloniki, Greece
| | - S. Vakalopoulou
- 2nd Internal Medicine Department Hippokratio General Hospital, Thessaloniki, Greece
| | - H. Zaboulis
- 2nd Internal Medicine Department Hippokratio General Hospital, Thessaloniki, Greece
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Sousos N, Gavriilaki E, Vakalopoulou S, Garipidou V. Understanding cardiovascular risk in hemophilia: A step towards prevention and management. Thromb Res 2016; 140:14-21. [DOI: 10.1016/j.thromres.2016.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 01/03/2023]
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Anagnostis P, Karras SN, Vakalopoulou S, Terpos E. Haemophilia and low bone mass. Ok, but what about fracture risk? Haemophilia 2016; 22:11-4. [DOI: 10.1111/hae.12833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/05/2015] [Indexed: 12/18/2022]
Affiliation(s)
- P. Anagnostis
- Second Propedeutic Department of Internal Medicine; Haemophilia Centre of Northern Greece; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
- Unit of Reproductive Endocrinology; First Department of Obstetrics and Gynecology; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - S. N. Karras
- Unit of Reproductive Endocrinology; First Department of Obstetrics and Gynecology; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - S. Vakalopoulou
- Second Propedeutic Department of Internal Medicine; Haemophilia Centre of Northern Greece; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - E. Terpos
- Department of Clinical Therapeutics; School of Medicine; Alexandra General Hospital; National and Kapodistrian University of Athens; Athens Greece
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Miltiades P, Lamprianidou E, Vassilakopoulos TP, Papageorgiou SG, Galanopoulos AG, Kontos CK, Adamopoulos PG, Nakou E, Vakalopoulou S, Garypidou V, Papaioannou M, Hatjiharissi E, Papadaki HA, Spanoudakis E, Pappa V, Scorilas A, Tsatalas C, Kotsianidis I. The Stat3/5 Signaling Biosignature in Hematopoietic Stem/Progenitor Cells Predicts Response and Outcome in Myelodysplastic Syndrome Patients Treated with Azacitidine. Clin Cancer Res 2015; 22:1958-68. [PMID: 26700206 DOI: 10.1158/1078-0432.ccr-15-1288] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/26/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Azacitidine is the mainstay of high-risk myelodysplastic syndromes (MDS) therapy, but molecular predictors of response and the mechanisms of resistance to azacitidine remain largely unidentified. Deregulation of signaling via Stat3 and Stat5 in acute myeloid leukemia (AML) is associated with aggressive disease. Numerous genes involved in cell signaling are aberrantly methylated in MDS, yet the alterations and the effect of azacitidine treatment on Stat3/5 signaling in high-risk MDS have not been explored. EXPERIMENTAL DESIGN We assessed longitudinally constitutive and ligand-induced phospho-Stat3/5 signaling responses by multiparametric flow cytometry in 74 patients with MDS and low blast count AML undergoing azacitidine therapy. Pretreatment Stat3/5 signaling profiles in CD34(+)cells were grouped by unsupervised clustering. The differentiation stage and the molecular properties of the CD34(+)G-CSF-inducible Stat3/5 double-positive subpopulation were performed by flow cytometry and quantitative real-time PCR in isolated MDS progenitors. RESULTS The pretreatment Stat3/5 signaling profiles in CD34(+)cells correlated strongly with response and cytogenetics and independently predicted event-free survival. We further identified a CD34(+)G-CSF-inducible Stat3/5 double-positive subpopulation (DP subset) whose pretreatment levels were inversely associated with treatment response and cytogenetics. The kinetics of the DP subset followed the response to azacitidine and the disease course, whereas its molecular characteristics and cellular hierarchy were consistent with a leukemia propagating cell phenotype. CONCLUSIONS Our findings provide a novel link among Stat3/5 signaling and MDS pathobiology and suggest that the Stat3/5 signaling biosignature may serve as both a response biomarker and treatment target.
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Affiliation(s)
- Paraskevi Miltiades
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Theodoros P Vassilakopoulos
- Department of Hematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios G Papageorgiou
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Athens, Greece
| | | | - Christos K Kontos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis G Adamopoulos
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Nakou
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sofia Vakalopoulou
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Vassilia Garypidou
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Maria Papaioannou
- Department of Haematology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Evdoxia Hatjiharissi
- Department of Hematology, Theageneion Hospital of Thessaloniki, Thessaloniki, Greece
| | - Helen A Papadaki
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Emmanuil Spanoudakis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vassiliki Pappa
- Second Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Athens, Greece
| | - Andreas Scorilas
- Department of Biochemistry and Molecular Biology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece.
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11
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Vlachaki E, Neokleous N, Paspali D, Vetsiou E, Onoufriadis E, Sousos N, Hissan S, Vakalopoulou S, Garypidou V, Boura P. Evaluation of Mental Health and Physical Pain in Patients with β-Thalassemia Major in Northern Greece. Hemoglobin 2015; 39:169-72. [PMID: 25976778 DOI: 10.3109/03630269.2015.1031244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
β-Thalassemia major (β-TM) is a chronic, genetic blood disorder. Patients are considered to be vulnerable to emotional and behavioral problems. The aim of this study was to assess mental health and somatic pain of patients with homozygous β-TM, who are systematically transfused in our unit. In this survey, 54 adult patients were studied. The general health questionnaire (GHQ-28) was used as mental health assessment model aimed at detecting mental disorders. The model of Binary was used as scoring method of GHQ-28. Overall ratings below 5 indicate no psychiatric problem, while a total score over or equal to 5 indicated the likelihood of a psychiatric disorder. The visual analogue scale (VAS) of pain was used as model for pain evaluation. One out of four examined patients who presented with a GHQ-28 score above or equal to 5 had an increased chance of being diagnosed with a psychiatric disorder. Concerning the pain, the majority of the studied patients scored between 1 and 3, meaning that they were feeling mild pain. There was no statistical significant correlation between age and GHQ-28 score. There was a statistical significant correlation between age and somatic symptoms (p = 0.026), anxiety and somatic symptoms (0.004) as well as anxiety and depression (p = 0.022). Thalassemic patients tend to be diagnosed with psychiatric disorders and it seems that they do not feel severe pain. More quantitative and comprehensive studies have to be conducted in order to estimate specific effective factors in psychosocial health.
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Affiliation(s)
- Efthymia Vlachaki
- Adult Thalassemia Unit, 2nd Department of Internal Medicine, Aristotle University, Hippokration Hospital , Thessaloniki , Greece
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12
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Agapidou A, Vakalopoulou S, Papadopoulou T, Chadjiaggelidou C, Garypidou V. Successful Treatment of Severe Anemia using Erythropoietin in a Jehovah Witness with Non-Hodgkin Lymphoma. Hematol Rep 2014; 6:5600. [PMID: 25568760 PMCID: PMC4274479 DOI: 10.4081/hr.2014.5600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/17/2014] [Accepted: 10/03/2014] [Indexed: 11/23/2022] Open
Abstract
Blood transfusion many times works in a life-saving way when a patient is facing a critical situation. However, some patients, such as Jehovah’s Witnesses, may refuse their administration because it opposes to their religion beliefs. Thus, clinicians are forced to respect patients’ preferences and seek other treatments in order to overcome the obstacle of the transfusion. In 1989, recombinant human erythropoietin (rHuEPO) was approved by the United States Food and Drug Administration (FDA) for the treatment of anemia associated with chronic renal failure. This is an amino acid glycol-protein that stimulates red blood cell production in the same manner as endogenous erythropoietin. Other treatment indications approved by the FDA include anemia due to chronic kidney disease, anemia secondary to zidovudine therapy in patients with human immunodeficiency virus infection, and anemia secondary to cancer chemotherapy. The drug also has been used for many off-label indications. Many Jehovah’s Witnesses have accepted rHuEPO as a treatment option to maintain and enhance erythropoiesis. This paper reports the case of a 57-year-old Jehovah’s Witness man, who was diagnosed with severe anemia due to aggressive non Hodgkin lymphoma and refused transfusion of blood; thanks to the treatment with rHuEPO he has managed to complete chemotherapy and has survived a life threatening situation.
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Affiliation(s)
- Alexandra Agapidou
- Department of Hematology, Second Propaedeutic Internal Medicine, Aristotle University of Thessaloniki , Greece
| | - Sofia Vakalopoulou
- Department of Hematology, Second Propaedeutic Internal Medicine, Aristotle University of Thessaloniki , Greece
| | - Theodosia Papadopoulou
- Department of Hematology, Second Propaedeutic Internal Medicine, Aristotle University of Thessaloniki , Greece
| | - Christina Chadjiaggelidou
- Department of Hematology, Second Propaedeutic Internal Medicine, Aristotle University of Thessaloniki , Greece
| | - Vasileia Garypidou
- Department of Hematology, Second Propaedeutic Internal Medicine, Aristotle University of Thessaloniki , Greece
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13
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Paschou SA, Anagnostis P, Karras S, Annweiler C, Vakalopoulou S, Garipidou V, Goulis DG. Bone mineral density in men and children with haemophilia A and B: a systematic review and meta-analysis. Osteoporos Int 2014; 25:2399-407. [PMID: 25001982 DOI: 10.1007/s00198-014-2773-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/10/2014] [Indexed: 11/28/2022]
Abstract
SUMMARY Although haemophilia is not considered among the classic causes of secondary osteoporosis, the present meta-analysis provides strong evidence that men with haemophilia have a significant reduction in both lumbar spine and femoral bone mineral density, which appears to begin in childhood. INTRODUCTION Haemophilia is not considered among the classic causes of secondary osteoporosis. The aim of this study was to systematically review the literature for case-control trials that have studied bone mass in males with haemophilia and to meta-analyze the best evidence available. METHODS Electronic databases MEDLINE, EMBASE and CENTRAL were systematically searched for case-control trials that have studied bone mass in men or boys with haemophilia. Standardized mean difference (SMD) for bone mineral density (BMD) in the lumbar spine was the main study outcome and SMD in femoral neck and total hip BMD the secondary ones. Patient and control characteristics, such as age, body mass index (BMI), level of physical activity and blood-borne infections were recorded as possible predictors of the main outcome. RESULTS Thirteen studies were included in the systematic review and ten in the main outcome meta-analysis. Men with haemophilia demonstrated reduced lumbar spine [random effects SMD [95 % confidence interval (CI)] = -0.56 (-0.84, -0.28), between-study heterogeneity (I (2)) = 51 %] and femoral neck BMD [random effects SMD (95 % CI) = -0.82 (-1.21, -0.44), I (2) = 63 %] compared with controls, which indicated a large and clinically significant association. Similar results were obtained for children [random effects SMD (95 % CI) = -0.92 (-1.77, -0.07), I (2) = 92 %]. No evidence of publication bias was detected. There was no evidence that age, BMI, level of physical activity or presence of blood-borne infections predicted lumbar spine BMD. CONCLUSIONS This meta-analysis shows that men with haemophilia present a significant reduction in both lumbar spine and hip BMD, which appears to begin in childhood.
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Affiliation(s)
- S A Paschou
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki Medical School, "Papageorgiou" General Hospital, Ring Road, 56403, Nea Efkarpia, Thessaloniki, Greece
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14
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Miltiades P, Lamprianidou E, Vassilakopoulos TP, Papageorgiou SG, Galanopoulos AG, Vakalopoulou S, Garypidou V, Papaioannou M, Hadjiharissi E, Pappa V, Papadaki HA, Spanoudakis E, Tsatalas K, Kotsianidis I. Expression of CD25 antigen on CD34+ cells is an independent predictor of outcome in late-stage MDS patients treated with azacitidine. Blood Cancer J 2014; 4:e187. [PMID: 24583533 PMCID: PMC3944665 DOI: 10.1038/bcj.2014.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- P Miltiades
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | - E Lamprianidou
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | - T P Vassilakopoulos
- Department of Hematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - S G Papageorgiou
- Second Department of Internal Medicine, Hematology Unit, University General Hospital Atticon, Athens, Greece
| | - A G Galanopoulos
- Department of Clinical Hematology, G. Gennimatas Hospital, Athens, Greece
| | - S Vakalopoulou
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - V Garypidou
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - M Papaioannou
- Department of Haematology, Aristotelion University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - E Hadjiharissi
- Department of Hematology, Theageneion Hosp. of Thessaloniki, Thessaloniki, Greece
| | - V Pappa
- Second Department of Internal Medicine, Hematology Unit, University General Hospital Atticon, Athens, Greece
| | - H A Papadaki
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - E Spanoudakis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | - K Tsatalas
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | - I Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
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Theodoridou S, Economou M, Vyzantiadis TA, Teli A, Vlachaki E, Neokleous N, Kargioti A, Vakalopoulou S, Garypidou V, Gombakis N, Papachristou F. Laboratory investigation of platelet function in patients with thalassaemia. Acta Haematol 2014; 132:45-8. [PMID: 24434633 DOI: 10.1159/000355817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 09/17/2013] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate platelet function in patients with thalassaemia and to detect any relation to chelation treatment (deferasirox or deferiprone/deferiprone plus desferioxamine). Thirty-three transfusion-dependent patients with thalassaemia were included. The investigation consisted of aggregation testing of platelet-rich plasma by light transmission aggregometry (LTA) with the use of 5 agonists as well as the global test of haemostasis by means of the PFA-100 platelet function analyser. In 66.67% of the patients, there was reduced LTA to at least one agonist and in 18.18% there was reduced LTA to two or more agonists. The PFA-100 test was prolonged in 60.6% of the cases. An abnormal LTA and a prolonged PFA-100 time were recorded in 33.3% of the patients and 27.4% had a normal aggregation and PFA-100 test. No correlation between chelation regimen and either LTA or PFA-100 test was found. The abnormal LTA can be explained either by the release of ADP from the haemolysed red blood cells, which leads to defective platelet aggregation, or by the presence of two platelet populations. An in vitro effect without an in vivo impact could be an alternative explanation. In patients with thalassaemia, the reduced LTA and the prolonged PFA-100 closure time could be an in vitro effect and has a close correlation to the bleeding phenotype of each patient.
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Affiliation(s)
- S Theodoridou
- Thalassaemia Unit, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
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Anagnostis P, Vakalopoulou S, Karras S, Charizopoulou M, Garipidou V. The role of arthropathy in the development of osteoporosis in patients with haemophilia: do we need more? Haemophilia 2013; 20:e83-5. [PMID: 24165289 DOI: 10.1111/hae.12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
Affiliation(s)
- P Anagnostis
- Haemophilia Centre of Northern Greece, Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Anagnostis P, Vakalopoulou S, Vyzantiadis TA, Charizopoulou M, Karras S, Goulis DG, Karagiannis A, Gerou S, Garipidou V. The clinical utility of bone turnover markers in the evaluation of bone disease in patients with haemophilia A and B. Haemophilia 2013; 20:268-75. [PMID: 24118364 DOI: 10.1111/hae.12271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 01/01/2023]
Abstract
Haemophilia A and B have been associated with increased prevalence of low bone mineral density (BMD). However, the utility of bone turnover markers (BTM) remains unknown. The aim of this study was to evaluate bone metabolism in men with haemophilia and to investigate associations between BTM and bone disease. Serum N- (NTX-I), C-terminal telopeptide of type I collagen (CTX-I) and tartrate-resistant acid phosphatase band-5b (TRAP-5b), as bone resorption markers, and osteocalcin (OC) and bone-specific alkaline phosphatase (b-ALP), as bone formation markers, were assessed. Seventy men with haemophilia A (n = 59) or B (n = 11) were studied. Patients with low BMD had significantly higher b-ALP concentrations compared with those with normal BMD (12.8 ± 1.60 vs. 9.72 ± 0.58 μg/L, P = 0.009), without any differences in the other BTM. NTX-I and CTX-I concentrations were negatively associated with oestradiol levels and hip BMD and positively with human immunodeficiency virus infection, number of affected joints and arthropathy scores. B-ALP and OC concentrations were negatively associated with hip BMD, severity of haemophilia and fracture history, and positively with the number of affected joints and testosterone concentrations. After multivariate analysis, NTX-I levels remained negatively associated with oestradiol levels, whereas b-ALP concentrations negatively correlated with the level of physical activity and positively with the number of affected joints. Increased bone metabolism exists in men with haemophilia and low BMD. Increased b-ALP levels may identify patients at high risk for fracture. Increased number of target joints, low physical activity and low oestradiol concentrations are independently associated with increased bone metabolism.
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Affiliation(s)
- P Anagnostis
- Haemophilia Centre of Northern Greece, Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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18
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Anagnostis P, Vakalopoulou S, Charizopoulou M, Kazantzidou E, Chrysopoulou T, Moka E, Agapidou A, Zournatzi V, Garipidou V. Is there any association between leptin levels and bone mineral density in haemophiliac men? Arch Med Sci 2013; 9:459-65. [PMID: 23847667 PMCID: PMC3701978 DOI: 10.5114/aoms.2013.35341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 07/21/2012] [Accepted: 08/01/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Conflicting data exist regarding the role of leptin in bone metabolism. The purpose of the present study was to investigate serum leptin concentrations in male patients with haemophilia A and B, a disease known to be associated with low bone mass. MATERIAL AND METHODS Eighty-one male patients, aged 45.4 ±15 years, were screened. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) in lumbar spine (LS), femoral neck (FN) and total hip (TH). RESULTS Low bone mass was diagnosed in 20 patients (24.7%). Serum leptin concentrations were strongly associated with body weight (r s = 0.457, p = 0.0001) and body mass index (BMI) (r s = 0.491, p = 0.0001). In unadjusted analysis leptin was inversely associated with BMD in LS (r s = -0.255, p = 0.023), but not in FN and TH (r s = -0.205, p = 0.068 and r s = -0.191, p = 0.090, respectively). However, after adjusting for BMI and body weight, leptin was inversely associated with BMD in FN (F 1,76 = 7.727, p = 0.007, β = -0.371, ΔR (2) = 0.089) and TH (F 1,76 = 4.533, p = 0.036, β = -0.290, ΔR (2) = 0.054), but not in LS (F 1,75 = 2.076, p = 0.154, β = -0.202, ΔR (2) = 0.026). No association was found between age, presence of HBV, HCV or HIV infection or alkaline phosphatase and leptin levels. CONCLUSIONS Our study showed a negative association between circulating leptin levels and bone mass in males, independently of body weight and BMI.
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Affiliation(s)
| | - Sofia Vakalopoulou
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Maria Charizopoulou
- Department of Psychology, School of Philosophy, Aristotle University of Thessaloniki, Greece
| | | | | | - Eleni Moka
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Alexandra Agapidou
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Vassiliki Zournatzi
- 2 Department of Obstetrics and Gynaecology, Aristotle University, Hippokration General Hospital, Thessaloniki, Greece
| | - Vasilia Garipidou
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
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Anagnostis P, Vakalopoulou S, Charizopoulou M, Karras S, Garipidou V. Vitamin D deficiency in patients with haemophilia: an underestimated commorbidity. Haemophilia 2013; 19:e308-10. [DOI: 10.1111/hae.12187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 12/28/2022]
Affiliation(s)
- P. Anagnostis
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki; Greece
| | - S. Vakalopoulou
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki; Greece
| | - M. Charizopoulou
- Department of Psychology; School of Philosophy; Aristotle University; Thessaloniki; Greece
| | - S. Karras
- Department of Endocrinology and Metabolism; Agios Pavlos General Hospital; Thessaloniki; Greece
| | - V. Garipidou
- Haemophilia Centre of Northern Greece; Second Propedeutic Department of Internal Medicine; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki; Greece
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20
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Affiliation(s)
- Panagiotis Anagnostis
- Second Propedeutic Department of Internal Medicine; Haemophilia Centre of Northern Greece; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki; Greece
| | - Vasilia Garipidou
- Second Propedeutic Department of Internal Medicine; Haemophilia Centre of Northern Greece; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki; Greece
| | | | - Sofia Vakalopoulou
- Second Propedeutic Department of Internal Medicine; Haemophilia Centre of Northern Greece; Medical School; Aristotle University of Thessaloniki; Hippokration Hospital; Thessaloniki; Greece
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Diplaris KT, Karfis EA, Ampatzidou F, Ananiadou OG, Vakalopoulou S, Madesis A, Asteri T, Drossos G. Acute Type-A Dissection in a Patient with Severe Hemophilia A. J Cardiothorac Vasc Anesth 2012; 26:660-3. [DOI: 10.1053/j.jvca.2011.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Indexed: 11/11/2022]
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22
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Anagnostis P, Vakalopoulou S, Slavakis A, Charizopoulou M, Kazantzidou E, Chrysopoulou T, Vyzantiadis TA, Moka E, Agapidou A, Garipidou V. Reduced bone mineral density in patients with haemophilia A and B in Northern Greece. Thromb Haemost 2012; 107:545-51. [PMID: 22318743 DOI: 10.1160/th11-08-05563] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/16/2011] [Indexed: 11/05/2022]
Abstract
Haemophilia A and B has been associated with increased prevalence of low bone mass (67-86%). The aim of this study was to estimate the prevalence of bone disease in haemophiliacs and its association with potential risk factors. Adult patients with haemophilia A and B followed-up in the Haemophilia Centre of Northern Greece were included. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) in lumbar spine (LS), femoral neck (FN), total hip (TH) and great trochanter (GT). One-hundred four male patients (aged 45.8 ± 15.1 years) and 50 controls (aged 44.9 ± 12.8 years) were screened. Low BMD was diagnosed in 28 patients (26.9%) and 10 controls (20%) (p=0.0001). Patients had lower BMD in TH (p=0.007), FN (p=0.029) and GT (p=0.008) than controls, without differences in LS. BMD was positively associated with the severity of haemophilia, history of herpes virus C or human immunodeficiency virus and level of physical activity, and negatively with the level of arthropathy. In multiple-regression analysis, only the level of physical activity and 25-hydroxyvitamin D [25(OH)D] significantly predicted BMD. Half of the patients had vitamin D deficiency. In conclusion, our study showed increased prevalence of low BMD in haemophiliacs. The levels of physical activity and 25(OH)D independently predicted low BMD.
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Bouchliou I, Miltiades P, Nakou E, Spanoudakis E, Goutzouvelidis A, Vakalopoulou S, Garypidou V, Kotoula V, Bourikas G, Tsatalas C, Kotsianidis I. Th17 and Foxp3(+) T regulatory cell dynamics and distribution in myelodysplastic syndromes. Clin Immunol 2011; 139:350-9. [PMID: 21444247 DOI: 10.1016/j.clim.2011.03.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 01/20/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
Abstract
Foxp3(+) T regulatory cells (Tregs) and Th17 cells accumulate synchronously at tumor sites during cancer progression, where their interplay is apparently affecting the efficiency of the antitumor response. In myelodysplastic syndromes, a hematopoietic malignancy of myeloid origin, Tregs are highly increased in the late stages of the disease (L-MDS), but the mechanisms driving Treg expansion and the interaction between Treg and Th17 cell dynamics are still unknown. We demonstrate that the proliferative capacity of Tregs is deficient during the early MDS stages (E-MDS), while in L-MDS it returns to normal levels. In addition, synchronously to Treg expansion, L-MDS patients exhibit increased numbers of functionally competent bone marrow IL-17(+) and FOXP3(+)/IL-17(+) cells, in contrast to E-MDS patients, where Th17 cells are significantly decreased and hypofunctional. Our findings suggest similar kinetics of Treg and Th17 cells between MDS and solid tumors, indicating a common immune pathogenetic pathway between diverse cancer types.
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Affiliation(s)
- Irene Bouchliou
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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Lefkou E, Vakalopoulou S, Fragakis N, Karamanos D, Mamopoulos A, Kleta D, Perifanis B, Garipidou V. P.69 Venous thromboembolism in women; One year experience from a thrombophilia clinic. Thromb Res 2011. [DOI: 10.1016/s0049-3848(11)70124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lefkou E, Mamopoulos A, Vakalopoulou S, Perifanis B, Aggelidou S, Theodoridou S, Moka E, Garipidou V. P.71 Recurrent miscarriage and gestational vascular complications; one year experience from a haematology-obstetric joint clinic. Thromb Res 2011. [DOI: 10.1016/s0049-3848(11)70126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lefkou E, Vakalopoulou S, Mamopoulos A, Fragakis N, Perifanis V, Moka E, Katsarou Z, Garipidou V. P.70 Antiphospholipid syndrome in Eve; Clinical observations, phenotypes and correlations. Thromb Res 2011. [DOI: 10.1016/s0049-3848(11)70125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vassiliadis T, Mpoumponaris A, Vakalopoulou S, Giouleme O, Gkissakis D, Grammatikos N, Soufleris K, Kakafika A, Tziomalos K, Patsiaoura K, Papanikolaou V, Evgenidis N. Spur cells and spur cell anemia in hospitalized patients with advanced liver disease: Incidence and correlation with disease severity and survival. Hepatol Res 2010; 40:161-70. [PMID: 20070401 DOI: 10.1111/j.1872-034x.2009.00590.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Spur cell anemia (SCA) is a form of acquired hemolytic anemia seen in patients with advanced cirrhosis and particularly in patients with alcoholic cirrhosis. The aim of the present study was to evaluate the incidence of spur cells and spur cell anemia in patients with advanced liver disease and to correlate the presence of spur cell anemia with survival. METHODS During a 33-month period, all patients with advanced cirrhosis (Child-Pugh-Turcott score [CPT]>/=7] who were hospitalized in our department for various reasons were included in this study. RESULTS A total of 54 patients were included in the study; 26 patients had spur cells on peripheral blood smear (median 4, range 1-14). Patients with spur cells had more advanced liver disease compared with those without spur cells (CPT score, P < 0.0001 and MELD score, P < 0.0001), lower hemoglobin levels (P < 0.0001), higher bilirubin levels (total/unconjugated, P < 0.0001), higher reticulocyte count (P < 0.0001) and more prolonged international normalized ratio (INR; P < 0.0001). Patients with 5% spur cells or more had more advanced disease compared with patients with 1-4% spur cells (CPT score, P = 0.004 and MELD score, P = 0.003), lower hemoglobin levels (P = 0.033), more elevated bilirubin levels (total/unconjugated, P = 0.006) and more prolonged INR (P = 0.04). Three-month survival was lower in patients with spur cells compared with patients without spur cells (P = 0.017 and P = 0.104, respectively). Patients with 5% spur cells or more had lower 3-month survival compared with those with 1-4% spur cells (P = 0.014). CONCLUSION Presence of spur cells in patients with advanced cirrhosis is not always accompanied by spur cell anemia. The presence of 5% spur cells or more and/or hemolytic anemia is associated with poor prognosis and these patients might have to be given priority for liver transplantation.
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Affiliation(s)
- Themistoklis Vassiliadis
- Gastroenterology and Hepatology Division, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Abstract
Afibrinogenemia is a rare bleeding disorder with an estimated prevalence of 1:1,000,000. It is an autosomal recessive disease resulting from mutations in any of the 3 genes that encode the 3 polypeptide chains of fibrinogen and are located on the long arm of chromosome 4. Spontaneous bleeding, bleeding after minor trauma and excessive bleeding during interventional procedures are the principal manifestations. We review the management of afibrinogenemia. Replacement therapy is the mainstay of treatment of bleeding episodes in these patients and plasma-derived fibrinogen concentrate is the agent of choice. Cryoprecipitate and fresh frozen plasma are alternative treatments that should be used only when fibrinogen concentrate is not available. Secondary prophylactic treatment may be considered after life-threatening bleeding whereas primary prophylactic treatment is not currently recommended. We also discuss alternative treatment options and the management of surgery, pregnancy and thrombosis in these patients. The development of new tests to identify higher risk patients and of safer replacement therapy will improve the management of afibrinogenemia in the future.
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Affiliation(s)
- Konstantinos Tziomalos
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
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Anagnostis P, Vakalopoulou S, Slavakis A, Simoulidou E, Rakitzi P, Garipidou V, Harsoulis F. Hypoglycemia in a patient with advanced Sezary syndrome. Leuk Lymphoma 2009; 50:284-6. [DOI: 10.1080/10428190802582652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Non-Hodgkin's lymphoma (NHL) of the breast may be primary or secondary. Both are rare and there are no morphological criteria to make the differential diagnosis. Benign intramammary lymph nodes are often encountered, but the development of either primary or secondary lymphoma within an intramammary lymph node is extremely rare. We report the case of a 72-year-old woman who presented with a palpable mass in her right breast. A mammography showed a large intramammary lymph node from which a biopsy was taken. On morphological and immunohistochemical examination the tumor fulfilled the criteria of NHL originating in an intramammary lymph node. The patient received chemotherapy which led to the disappearance of the mass. A review of the literature revealed that this is the third reported case of primary NHL originating in an intramammary lymph node.
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Affiliation(s)
- Ioannis D Venizelos
- Department of Pathology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece.
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Mamopoulos A, Vakalopoulou S, Fileli A, Vosnakis C, Lefkou E, Garipidou V, Karagiannis V. P11 Congenital factor X deficiency and pregnancy: a case report. Thromb Res 2009. [DOI: 10.1016/s0049-3848(09)70056-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vakalopoulou S, Rizopoulou D, Zafiriadou E, Perifanis V, Tziomalos K, Lefkou E, Hill M, Dolan G, Garipidou V. Management of acute bleeding in a patient with congenital afibrinogenaemia. Haemophilia 2006; 12:676-8. [PMID: 17083521 DOI: 10.1111/j.1365-2516.2006.01340.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Congenital afibrinogenaemia is a rare bleeding disorder characterized by absence of fibrinogen and varying bleeding tendency. Treatment with fibrinogen concentrates is considered to be the best choice for afibrinogenaemic patients who experience bleeding. We report the case of a 22-year-old Greek patient who presented with large muscular haematomas and was treated with fibrinogen concentrates. The efficacy of this treatment and the problems that arose during his hospitalization are being discussed.
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Affiliation(s)
- S Vakalopoulou
- Haematology Section of Second Propedeutic, Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
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Perifanis V, Vyzantiadis T, Tziomalos K, Vakalopoulou S, Garipidou V, Athanassiou-Metaxa M, Harsoulis F. Effect of zoledronic acid on markers of bone turnover and mineral density in osteoporotic patients with beta-thalassaemia. Ann Hematol 2006; 86:23-30. [PMID: 17013645 DOI: 10.1007/s00277-006-0180-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 07/17/2006] [Indexed: 01/06/2023]
Abstract
Osteoporosis has emerged as an important cause of morbidity in patients with thalassemia major. Studies regarding the efficacy of bisphosphonates in thalassemia-induced osteoporosis have yielded conflicting results. We performed this prospective study to evaluate the efficacy of zoledronic acid in osteoporotic patients with thalassemia major. Patients, 29, were given 1 mg zoledronic acid intravenously every 3 months for a total of four doses. Twenty age- and sex-matched healthy blood donors served as controls. Before each infusion and 3 months after the last infusion, we determined serum levels of osteoprotegerin (OPG), N-terminal cross-linking telopeptide of type I collagen (NTX), osteocalcin (OC) and insulin-like growth factor 1 (IGF-1). Bone mineral density (BMD) of the lumbar spine was measured at baseline and after the treatment's completion. At baseline, OPG did not differ significantly between patients and controls (p=0.2), NTX were higher in patients although not significantly (p=0.139), whereas, OC levels were significantly higher and IGF-1 levels significantly lower in patients than in controls (p<0.001 and p<0.006, respectively). Zoledronic acid administration resulted in a significant decrease in NTX, OC and IGF-1 (p<0.05, p<0.001 and p<0.05, respectively) and in a significant increase in OPG and BMD (p<0.05 for both comparisons). The change in NTX, osteocalcin and IGF-1 became significant as early as 3 months after the first administration of zoledronic acid, while the change in OPG reached significance only after three infusions. Our study supports the effectiveness of bisphosphonates in the treatment of thalassemia-induced osteoporosis.
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Affiliation(s)
- Vassilios Perifanis
- Thalassaemia Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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Vassiliadis T, Garipidou V, Perifanis V, Tziomalos K, Giouleme O, Patsiaoura K, Avramidis M, Nikolaidis N, Vakalopoulou S, Tsitouridis I, Antoniadis A, Semertzidis P, Kioumi A, Premetis E, Eugenidis N. A case of successful management with splenectomy of intractable ascites due to congenital dyserythropoietic anemia type II-induced cirrhosis. World J Gastroenterol 2006; 12:818-21. [PMID: 16521204 PMCID: PMC4066141 DOI: 10.3748/wjg.v12.i5.818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The congenital dyserythropoietic anemias comprise a group of rare hereditary disorders of erythropoiesis, characterized by ineffective erythropoiesis as the predominant mechanism of anemia and by characteristic morphological aberrations of the majority of erythroblasts in the bone marrow. Congenital dyserythropoietic anemia type II is the most frequent type. All types of congenital dyserythropoietic anemias distinctly share a high incidence of iron loading. Iron accumulation occurs even in untransfused patients and can result in heart failure and liver cirrhosis. We have reported about a patient who presented with liver cirrhosis and intractable ascites caused by congenital dyserythropoietic anemia type II. Her clinical course was further complicated by the development of autoimmune hemolytic anemia. Splenectomy was eventually performed which achieved complete resolution of ascites, increase of hemoglobin concentration and abrogation of transfusion requirements.
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Affiliation(s)
- Themistoklis Vassiliadis
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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35
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Garipidou V, Vakalopoulou S, Tziomalos K. Development of multiple myeloma in a patient with chronic myeloid leukemia after treatment with imatinib mesylate. Oncologist 2005; 10:457-8. [PMID: 15967839 DOI: 10.1634/theoncologist.10-6-457] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Vassiliadis T, Garipidou V, Tziomalos K, Perifanis V, Giouleme O, Vakalopoulou S. Prevention of hepatitis B reactivation with lamivudine in hepatitis B virus carriers with hematologic malignancies treated with chemotherapy--a prospective case series. Am J Hematol 2005; 80:197-203. [PMID: 16247746 DOI: 10.1002/ajh.20471] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Administration of immunosuppressive treatment in hepatitis B virus carriers with malignancies is associated with the risk of hepatitis B reactivation. This complication is more frequent in patients with hematologic malignancies because administration of corticosteroids, the mainstay of treatment of these patients, is an independent risk factor for hepatitis B reactivation. When lamivudine is given prior to chemotherapy, it prevents the viral replication during the immunosuppression period; therefore, it might reduce the risk of hepatitis B exacerbation. We performed a prospective study to assess the efficacy of prophylactic administration of lamivudine in this setting. Ten hepatitis B virus carriers with hematologic malignancies were included in this study; seven were HBsAg positive, and three had isolated antiHBc and detectable HBV-DNA levels. Nine patients were given corticosteroids after the administration of lamivudine. Lamivudine was given per os at a dose of 100 mg once daily. In four patients that had not been previously treated with chemotherapy, lamivudine was started 19 days (median) (range, 0-35 days) prior to the onset of chemotherapy. The administration of lamivudine has not stopped since in any of our patients. After a median follow-up of 15 months (range 6-38 months), no hepatitis B reactivation was observed. HBV-DNA levels were decreased in all 6 patients who had detectable HBV-DNA at baseline. Lamivudine was well tolerated. Chemotherapy regimens were administered as planned, and their effectiveness was not compromised by lamivudine. In conclusion, prophylactic administration of lamivudine should be considered as a means of reducing the frequency of hepatitis B reactivation in hepatitis B virus carriers with hematologic malignancies who are being treated with chemotherapy.
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Affiliation(s)
- Themistoklis Vassiliadis
- 2nd Propedeutic Department of Internal Medicine, Aristotelian University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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Nikolaidis N, Giouleme O, Grammatikos N, Tziomalos K, Zezos P, Vakalopoulou S, Venizelos I, Garipidou V, Eugenidis N. Multifocal mucosa-associated lymphoid tissue lymphoma presenting as lower-GI bleeding. Gastrointest Endosc 2005; 62:465-7. [PMID: 16111978 DOI: 10.1016/j.gie.2005.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 04/27/2005] [Indexed: 02/08/2023]
Affiliation(s)
- Nikolaos Nikolaidis
- Gastroenterology and Haematology Sections of 2nd Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
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38
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Affiliation(s)
- Ioannis D Venizelos
- Department of Pathology, Hippokration General Hospital, Thessaloniki, Greece.
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Garipidou V, Vakalopoulou S, Zafiriadou E, Kaloutsi V, Tziomalos K, Perifanis V. Uncommon manifestation of bleomycin-induced pulmonary toxicity in a patient with Hodgkin's disease. Ann Oncol 2005; 16:514-5. [PMID: 15668264 DOI: 10.1093/annonc/mdi073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Abstract
Involvement of the gastrointestinal (GI) tract by multiple myeloma (MM) is extremely rare. The small intestine and stomach are the most frequent sites of spread. We report 1 case of a 61-year-old woman who presented with clinical and radiographic features of an acute large bowel pseudo-obstruction. An abdominal computerized tomography (CT) showed a large tumor of the rectum. On morphological and immunohistochemical examination the tumor fulfilled the criteria of MM. The patient received combined chemotherapy and radiotherapy which led to the disappearance of the tumor. A review of the literature revealed that this is the first reported case of MM presented as acute large bowel pseudo-obstruction due to a rectal myeloma tumor.
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Affiliation(s)
- Ioannis Venizelos
- Department of Pathology, Hippokration General Hospital, Thessaloniki, Greece.
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Krikis N, Tziomalos K, Perifanis V, Vakalopoulou S, Karagiannis A, Garipidou V, Harsoulis F. Treatment of recurrent gastrointestinal haemorrhage in a patient with von Willebrand's disease with octreotide LAR and propranolol. Gut 2005; 54:171-2. [PMID: 15591529 PMCID: PMC1774363 DOI: 10.1136/gut.2004.049031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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42
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Perifanis V, Sfikas G, Tziomalos K, Vakalopoulou S, Garipidou V. Hereditary spherocytosis uncovered in adulthood due to concomitant lead poisoning. Ann Hematol 2004; 84:131-2. [PMID: 15503017 DOI: 10.1007/s00277-004-0962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 09/26/2004] [Indexed: 10/26/2022]
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Kaloyannidis P, Sakellari I, Fassas A, Fragia T, Vakalopoulou S, Kartsios C, Garypidou B, Kimiskidis V, Anagnostopoulos A. Acquired hemophilia-A in a patient with multiple sclerosis treated with autologous hematopoietic stem cell transplantation and interferon beta-1a. Bone Marrow Transplant 2004; 34:187-8. [PMID: 15195073 DOI: 10.1038/sj.bmt.1704550] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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45
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Perifanis V, Vyzantiadis T, Vakalopoulou S, Tziomalos K, Garypidou V, Athanassiou-Metaxa M, Harsoulis F. Treatment of beta-thalassaemia-associated osteoporosis with zoledronic acid. Br J Haematol 2004; 125:91-2; author reply 93-4. [PMID: 15015977 DOI: 10.1111/j.1365-2141.2004.04871.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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46
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Garypidou V, Vakalopoulou S, Dimitriadis D, Tziomalos K, Sfikas G, Perifanis V. Incidence of pulmonary hypertension in patients with chronic myeloproliferative disorders. Haematologica 2004; 89:245-6. [PMID: 15003906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- Vasilia Garypidou
- Hematology Dept, 2nd Prop Dept of Internal Medicine, Aristotelian University of Thessaloniki, Ippokration General Hospital, Thessaloniki, Greece
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Krikis N, Tziomalos K, Perifanis V, Vakalopoulou S, Karagiannis A, Garypidou V, Harsoulis F. Treatment of recurrent gastrointestinal haemorrhage in a patient with von Willebrand's disease with administration of octreotide LAR and propranolol. Hormones (Athens) 2004; 3:65-7. [PMID: 16982580 DOI: 10.14310/horm.2002.11114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a patient with von Willebrand' s disease who had had recurrent and life-threatening bleeding from the gastrointestinal tract. Despite extensive investigation, no apparent cause of haemorrhage was identified. He was successfully treated with combined administration of octreotide LAR (long-acting release) and propranolol. This is the first report on the successful use of octreotide LAR in a patient with von Willebrand' s disease.
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Affiliation(s)
- Napoleon Krikis
- Second Propedeutic Department of Internal Medicine, Aristotelian University of Thessaloniki, Ippokration General Hospital, Thessaloniki, Greece
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Garypidou V, Verrou E, Vakalopoulou S, Perifanis V, Tziomalos K, Venizelos I. Efficacy of a single, weekly dose of recombinant erythropoietin in myelodysplastic syndromes. Br J Haematol 2003; 123:958. [PMID: 14632793 DOI: 10.1046/j.1365-2141.2003.04697.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Theodoridou S, Vyzantiadis T, Vakalopoulou S, Perifanis V, Tziomalos K, Vyzantiadis A, Garipidou V. Elevated levels of serum vascular endothelial growth factor in patients with polycythaemia vera. Acta Haematol 2003; 110:16-9. [PMID: 12975551 DOI: 10.1159/000072408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2002] [Accepted: 03/25/2003] [Indexed: 11/19/2022]
Abstract
Angiogenesis seems to be a prominent event of myeloproliferative diseases. There are few reported data on angiogenesis and the significance of its stimulator, the vascular endothelial growth factor (VEGF), in polycythaemia vera (PV). We report our observation of elevated serum VEGF levels in patients suffering from PV. Twenty patients with PV and 20 age-matched healthy subjects were enrolled. VEGF levels were measured by a quantitative sandwich enzyme immunoassay. Serum VEGF levels in PV were found to be very significantly higher than in healthy individuals (569.7 +/- 101.2 vs. 164.7 +/- 32.8 pg/ml, p = 0.001). We found no correlation between VEGF and haemoglobin, platelet or leucocyte counts in the patient group. Different therapeutic regimens had no influence on VEGF levels. However, in the control group, we observed a positive correlation between VEGF levels and platelet counts (r = 0.52, p = 0.02). Platelet counts did not differ between patients and healthy subjects. We also evaluated platelet-poor plasma VEGF levels in 10 patients and in all healthy individuals. We found very low levels of VEGF, approximately zero in most cases, in both groups and there was obviously no difference between the two groups. Our results indicate that VEGF is overproduced in PV. However, follow-up studies are needed to verify the role of this factor.
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Affiliation(s)
- Stamatia Theodoridou
- Second Propedeutic Department of Internal Medicine, Aristotelion University of Thessaloniki, Thessaloniki, Greece.
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Vakalopoulou S, Mille-Baker B, Mumford A, Manning R, Laffan M. Fibrinogen Bbeta14 Arg-->Cys: further evidence for a role in thrombosis. Blood Coagul Fibrinolysis 1999; 10:403-8. [PMID: 10695765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
A single base substitution (C-->T) in exon II of the Bbeta fibrinogen gene resulting in an Arg14-->Cys replacement was identified in a young woman with a history of recurrent thrombotic stroke. The patient's plasma showed prolongation of the thrombin and Reptilase times, and plasma fibrinogen, which was low when determined by chronometric assay (Clauss technique) was normal by clot weight. Dysfibrinogenaemia associated with the same mutation was identified in eight family members including two siblings with a history of venous and arterial thrombosis. Fibrin monomer polymerization with thrombin, Reptilase and Agkistrodon contortrix contortrix venom was defective. Polymerization studies revealed a reduced rate of polymerization compared with normal plasma, which improved on cooling from 37 degrees C to 20 degrees C. Plasma viscosity in the affected individuals was normal. Flow cytometric analysis of platelets from the proband and another affected member showed no increase in surface bound fibrinogen. Euglobulin clot lysis time was normal. The same point mutation has been described previously in individuals with thrombosis. This family adds further to the genotype-phenotype correlation of the dysfibrinogenaemias and provides strong evidence for a genuine association of fibrinogen BbetaArg14Cys with thrombosis. The mechanism underlying a causal relationship with the increased incidence of thrombosis remains obscure but a review of related dysfibrinogens suggests that the addition of a free thiol group rather than the loss of the thrombin cleavage site may be important.
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Affiliation(s)
- S Vakalopoulou
- Department of Haematology, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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