Asklepieion General Hospital

Athens, Greece

Asklepieion General Hospital

Athens, Greece
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Vlachopanos G.,Asklepieion General Hospital | Ghalli F.G.,University of Wales
Journal of Evidence-Based Medicine | Year: 2017

In the clinical context of end-stage renal disease (ESRD), thrombosis and bleeding risks are simultaneously increased and may have devastating consequences. While anticoagulant and antiplatelet drugs are indispensable for the prevention of thromboembolic events, the significantly higher bleeding risk makes their handling extremely complicated. In ESRD, they are frequently administered for a wide array of conditions. For example, atrial fibrillation is quite common in ESRD and warrants the use of anticoagulants like warfarin. Unfractionated heparin and low molecular weight heparins are typically used for clotting prevention in the hemodialysis extracorporeal circuit. The antithrombotics use dilemma has worsened because ESRD patients have been excluded from major clinical trials that defined standard indications, contraindications and optimal management of these medications. That limits our knowledge and results in that the process of decision-making depends on weaker data. Besides the substantial bleeding risk, warfarin may also increase cardiovascular risk because it is implicated in the pathogenesis of vascular calcifications in ESRD. The present article attempts to offer a comprehensive overview of practical considerations for the use of the most common antithrombotic medications in ESRD linking them, at the same time, to the best available evidence from randomized controlled trials and observational studies. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd


Kassimatis T.I.,Asklepieion General Hospital | Goldsmith D.J.A.,Guys Hospital Campus
Pharmacological Research | Year: 2014

HMG-CoA reductase inhibitors (statins) have been shown to improve cardiovascular (CV) outcomes in the general population as well as in patients with cardiovascular disease (CVD). Statins' beneficial effects have been attributed to both cholesterol-lowering and cholesterol-independent "pleiotropic" properties. By their pleiotropic effects statins have been shown to reduce inflammation, alleviate oxidative stress, modify the immunologic responses, improve endothelial function and suppress platelet aggregation. Patients with chronic kidney disease (CKD) exhibit an enormous increase in CVD rates even from early CKD stages. As considerable differences exist in dyslipidemia characteristics and the pathogenesis of CVD in CKD, statins' CV benefits in CKD patients (including those with a kidney graft) should not be considered unequivocal. Indeed, accumulating clinical evidence suggests that statins exert diverse effects on dialysis and non-dialysis CKD patients. Therefore, it seems that statins improve CV outcomes in non-dialysis patients whereas exert little (if any) benefit in the dialysis population. It has also been proposed that dyslipidemia might play a causative role or even accelerate renal injury. Moreover, ample experimental evidence suggests that statins ameliorate renal damage. However, a high quality randomized controlled trial (RCT) and metaanalyses do not support a beneficial role of statins in renal outcomes in terms of proteinuria reduction or retardation of glomerular filtration rate (GFR) decline. © 2014 Elsevier Ltd.


PubMed | University of Basel, Asklepieion General Hospital and National and Kapodistrian University of Athens
Type: | Journal: Journal of transplantation | Year: 2015

Background. Posttransplant recurrence of primary focal segmental glomerulosclerosis (rFSGS) in the form of massive proteinuria is not uncommon and has detrimental consequences on renal allograft survival. A putative circulating permeability factor has been implicated in the pathogenesis leading to widespread use of plasma exchange (PLEX). We reviewed published studies to assess the role of PLEX on treatment of rFSGS in adults. Methods. Eligible manuscripts compared PLEX or variants with conventional care for inducing proteinuria remission (PR) in rFSGS and were identified through MEDLINE and reference lists. Data were abstracted in parallel by two reviewers. Results. We detected 6 nonrandomized studies with 117 cases enrolled. In a random effects model, the pooled risk ratio for the composite endpoint of partial or complete PR was 0,38 in favour of PLEX (95% CI: 0,23-0,61). No statistical heterogeneity was observed among included studies (I (2) = 0%, p = 0,42). On average, 9-26 PLEX sessions were performed to achieve PR. Renal allograft loss due to recurrence was lower (range: 0%-67%) in patients treated with PLEX. Conclusion. Notwithstanding the inherent limitations of small, observational trials, PLEX appears to be effective for PR in rFSGS. Additional research is needed to further elucidate its optimal use and impact on long-term allograft survival.


PubMed | Asklepieion General Hospital and University of Thessaly
Type: Journal Article | Journal: Urology | Year: 2014

To investigate the impact of shock wave lithotripsy (SWL) on renal tissues using neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and interleukin 18 (IL-18) levels in serum and urine and to examine the relationship of these biomarkers with patient and calculus characteristics as well as SWL treatment parameters.Thirty-seven patients with renal calculi were included in this study. Blood and urine samples were attained from each patient at 4 time points; immediately before SWL, 6 hours after, 3 days after, and 10 days after the SWL. A new generation lithotripter was used for all cases. Serum and urine NGAL concentrations were measured using commercially available enzyme-linked immunosorbent assay kits according to manufactures protocol. The concentration of cystatin C was measured in serum, whereas IL-18 concentration was assessed in urine.There were no statistically significantly differences in the levels of NGAL in serum and urine before and after SWL. The mean levels of cystatin C in serum appeared significantly higher 3 and 10 days after SWL. No statistically significant differences were identified between levels of IL-18 before and after SWL. Patients with diabetes mellitus demonstrated significantly higher baseline cystatin C levels. There was no correlation between calculus characteristics or treatment parameters and the levels of all 3 biomarkers after SWL.The results of this study indicate that SWL is associated with minimal acute injury to renal tissues. Our findings support the safety profile of new generation lithotripters, provided orthodox indications and treatment principles are followed.


Mornos C.,Victor Babes University of Medicine and Pharmacy Timisoara | Manolis A.J.,Asklepieion General Hospital | Cozma D.,Victor Babes University of Medicine and Pharmacy Timisoara | Kouremenos N.,Asklepieion General Hospital | And 2 more authors.
Hellenic Journal of Cardiology | Year: 2014

Introduction: Anthracyclines are important anticancer drugs, but their use is limited by acute and chronic cardiotoxicity. Current approaches to surveillance are often inadequate to detect myocardial disease. Strain imaging might detect earlier myocardial dysfunction. Speckle analysis of three-dimensional (3D) echocardiography improves information about left ventricular (LV) segmental and global deformation by avoiding the loss of speckles seen in monoplane bidimensional-strain analysis. We assessed whether early 3D-strain analysis could predict later anthracycline-induced cardiotoxicity. Methods: Echocardiography, troponin T (TnT) and N-terminal pro-brain natriuretic peptide were used to evaluate 59 patients (age 51 ± 10 years) before, and at 12 and 36 weeks after anthracycline treatment. LV global longitudinal strain (3DGLS), global radial strain (3DGRS) and global circumferential strain (3DGCS) were determined using 3D-strain imaging before and after 12 weeks of chemotherapy. Percentage changes from baseline to 12 weeks after initiation of chemotherapy (Δ) were calculated for all parameters analysed. Results: During the follow-up period, eight patients (13.5%) developed cardiotoxicity. At 12 weeks after the initiation of chemotherapy, isovolumic relaxation time, 3DGLS, 3DGCS and 3DGRS had deteriorated and troponin was elevated (all p<0.05), before any decrease in LV ejection fraction. Cumulative anthracycline dose at 12 weeks, ΔLVEF, Δ3DGLS and ΔTnT were predictors of the later development of cardiotoxicity on univariate logistic regression. By multiple logistic regression, Δ3DGLS emerged as the only independent predictor of later cardiotoxicity (Odds ratio 1.09, p=0.04). Conclusions: Anthracycline therapy induced early deterioration of 3DGLS, 3DGCS and 3DGRS. Δ3DGLS seems to be a good predictor of the future development of anthracycline-induced cardiotoxicity.


Mornos C.,Institute of Cardiovascular Diseases | Rusinaru D.,Institute of Cardiovascular Diseases | Manolis A.J.,Asklepieion General Hospital | Zacharopoulou I.,Asklepieion General Hospital | And 2 more authors.
Hellenic Journal of Cardiology | Year: 2011

Introduction: Torsional and longitudinal deformations are essential components of left ventricular (LV) performance. We believe that a precise assessment of LV function must take into account both LV torsion (LVtor) and global longitudinal strain (LVε). Therefore, we investigated with speckle tracking echocardiography the value of a new parameter, LVtor × LVε, for assessing LV function in dilated cardiomyopathy (DCM) and validated it against N-terminal pro-brain natriuretic peptide (NTproBNP). Methods: Echocardiography was performed simultaneously with NTproBNP determination in 55 consecutive patients with DCM in sinus rhythm. The ratio of early diastolic transmitral velocity to early mitral annular diastolic velocity (E/E') was measured. LVtor was defined as the ratio between LV twist (LVtw) and LV enddiastolic longitudinal length. LVtw (net difference between rotation angles at base and apex) was obtained from parasternal apical and basal short-axis planes. LVε was obtained by averaging longitudinal peak systolic strain of all 17 LV-segments (from apical planes). Results: Log-transformed NTproBNP correlated significantly with LVε (r=0.56, p<0.001), E/E' (r=0.52, p<0.001), LVtor (r=-0.41, p=0.003), LVtw (r=-0.38, p=0.004) and LV ejection fraction (r=-0.37, p=0.005). LVtor × LVε had the strongest correlation with log-NTproBNP (r=0.71, p<0.001). LVtor × LVε was a better predictor of NTproBNP levels >900 pg/ml (sensitivity 73%, specificity 82%) than LVε, E/E', LVtw, LVtor and LV ejection fraction (each p<0.05). Conclusions: This study demonstrates that in patients with DCM in sinus rhythm, the evaluation of LV function can be accurately accomplished by using a new speckle tracking index, LVtor × LVε.


Vlachopanos G.,Asklepieion General Hospital | Kassimatis T.I.,Asklepieion General Hospital | Agrafiotis A.,Asklepieion General Hospital
Transplant International | Year: 2015

Delayed graft function (DGF) due to ischemia-reperfusion injury is a major early complication of kidney transplantation (KT). Recombinant human erythropoietin (rHuEPO) has been shown to exert nephroprotective action in animal models. We conducted a meta-analysis to explore the impact of rHuEPO on DGF in KT. Eligible studies comparing perioperative high-dose rHuEPO with placebo or no therapy for prevention of DGF were identified through MEDLINE, CENTRAL, and Transplant Library. Their design and data were assessed by two independent reviewers. Among 737 examined studies, four randomized controlled trials, involving 356 recipients of kidney allografts from deceased donors, fulfilled inclusion criteria. Statistical heterogeneity across studies was not significant (P = 0.98, I2 = 0%). In a random effects model, no significant difference was found in the occurrence of DGF (odds ratio: 0,74, 95% CI: 0.47-1.18, P = 0.21). At 4 weeks after KT, the rHuEPO group exhibited higher systolic blood pressure (mean difference: 6.47 mmHg, 95% CI: 1.25-11.68, P = 0.02). Perioperative, high-dose rHuEPO administration does not prevent DGF in deceased donor KT. Furthermore, it is associated with higher systolic blood pressure leading to safety concerns. Nonerythropoietic rHuEPO derivatives, designed for nephroprotective action without increasing cardiovascular risk, might prove an alternative but still are at early stages of development. © 2014 Steunstichting ESOT.


Patatoukas D.,Asklepieion General Hospital
Folia medica | Year: 2011

Athletes with disabilities are highly skilled. Sports-related injuries and disorders interfere with their efforts. Several aspects of these injuries have been studied in previous studies. The aim of this study was to correlate the types of injuries with the disability group in athletes with physical disabilities. One hundred and thirty nine elite athletes with physical disabilities completed a questionnaire about sports-related injuries that resulted in at least one day off from training or competition. All disability groups show soft tissue injuries in high percentages. Cerebral palsy (CP) athletes reported soft tissue injuries (P < 0.01) and lacerations (P < 0.001) in higher percentage than Other Disabled Athletes (ODA) and Spinal Cord Injured (SCI) athletes. Spinal cord injured athletes sustained fractures (P < 0.05) and blisters (P < 0.05) in higher percentages than the other groups. No differences were found between the studied groups for contusions, low back pain, ruptures, thermoregulation disorders, urinary tract infections, pressure sores and pneumonias. CP athletes sustained soft tissue injuries and lacerations more than other disability groups did because moving and walking patterns of this population add risk factors for such injuries. Fractures and blisters occur more frequently to SCI athletes because they participate in higher percentage in wheelchair basketball which is high risky sport.


PubMed | Asklepieion General Hospital
Type: Journal Article | Journal: Transplant international : official journal of the European Society for Organ Transplantation | Year: 2015

Delayed graft function (DGF) due to ischemia-reperfusion injury is a major early complication of kidney transplantation (KT). Recombinant human erythropoietin (rHuEPO) has been shown to exert nephroprotective action in animal models. We conducted a meta-analysis to explore the impact of rHuEPO on DGF in KT. Eligible studies comparing perioperative high-dose rHuEPO with placebo or no therapy for prevention of DGF were identified through MEDLINE, CENTRAL, and Transplant Library. Their design and data were assessed by two independent reviewers. Among 737 examined studies, four randomized controlled trials, involving 356 recipients of kidney allografts from deceased donors, fulfilled inclusion criteria. Statistical heterogeneity across studies was not significant (P = 0.98, I(2) = 0%). In a random effects model, no significant difference was found in the occurrence of DGF (odds ratio: 0,74, 95% CI: 0.47-1.18, P = 0.21). At 4 weeks after KT, the rHuEPO group exhibited higher systolic blood pressure (mean difference: 6.47 mmHg, 95% CI: 1.25-11.68, P = 0.02). Perioperative, high-dose rHuEPO administration does not prevent DGF in deceased donor KT. Furthermore, it is associated with higher systolic blood pressure leading to safety concerns. Nonerythropoietic rHuEPO derivatives, designed for nephroprotective action without increasing cardiovascular risk, might prove an alternative but still are at early stages of development.


PubMed | Asklepieion General Hospital
Type: Case Reports | Journal: Hemodialysis international. International Symposium on Home Hemodialysis | Year: 2015

Emphysematous pyelonephritis (EPN) is a life-threatening renal infection caused by gas-producing bacteria and fungi. It usually occurs in patients with diabetes and patients with urinary tract obstruction. A combination of systemic antibiotics, percutaneous catheter drainage, or open nephrectomy is typically required to achieve cure. Because of grim prognosis, resorting to interventional methods is frequently inevitable. We report the case of a 77-year-old woman with diabetes and end-stage renal disease on chronic hemodialysis that presented with fever and left flank pain. A bubbly gas pattern inside the left kidney was demonstrated on abdominal computed tomography scan and blood cultures grew Escherichia coli. She was successfully treated solely with systemic antibiotics. This highlights the fact that prompt recognition of imaging findings associated with benign prognosis is essential for a favorable outcome. It allows for an effective management avoiding high-risk interventions, especially in frail patients with multiple comorbidities. Finally, we review all published cases of EPN in chronic dialysis patients.

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