Managing Alzheimer's disease in primary care in Crete, Greece: room for improvement.

As Greece moves during the last two decades toward a national health care system, which gives emphasis to the development of a primary care system, many worry how to ensure that the quality of care is assessed. This is more apparent in the rural populations, in which health care is served to a large extent by physicians without formal training in general practice. This article explores the level of knowledge of primary care physicians in relation to Alzheimer's disease in geographically defined areas of Crete, Greece, in comparison with that of general practitioners in Ostergötland, Sweden, and in Iceland.

Nonneutropenic febrile episodes associated with docetaxel-based chemotherapy in patients with solid tumors.

Background: Docetaxel is associated with severe lymphopenia and increased incidence of nonneutropenic infection. This study investigated the incidence of nonneutropenic infections and/or febrile episodes in patients with solid tumors receiving frontline docetaxel-based chemotherapy.

Methods: Chemotherapy-naive patients with solid tumors treated with docetaxel-based chemotherapy were studied prospectively for the development of nonneutropenic infections.

Comparison of docetaxel/cisplatin to docetaxel/gemcitabine as first-line treatment of advanced non-small cell lung cancer: early results of a randomized trial.

The study compares docetaxel plus cisplatin (DC) and docetaxel plus gemcitabine (DG) regimens for the treatment of advanced non-small cell lung cancer (NSCLC). Patients were randomized to receive either the DC or the DG combination. They were stratified according to age, performance status (PS) and stage of disease.

Low expression of p27 protein combined with altered p53 and Rb/p16 expression status is associated with increased expression of cyclin A and cyclin B1 in diffuse large B-cell lymphomas.

The expression of the cyclin-dependent kinase inhibitor (CDKI) p27 protein was investigated in relation to (1) the expression of the cell cycle regulators p53, Rb and p16 and (2) the proliferation profile as determined by the expression of Ki67, cyclin A, and cyclin B1 in 80 cases of de novo diffuse large B-cell lymphomas (DLBCL). P27 expression was low/null in large tumor cells in 58/80 cases and intermediate/high in 22/80 cases. Increased expression of p53 protein was observed in 39/80 cases.

Seroprevalence of hepatitis A, B and C markers in Greek warship personnel.

A seroepidemiological study was conducted to assess the seroprevalence of hepatitis A, B and C markers in 285 males (mean age: 24.4+/-4.4 years) aboard a Greek warship.

Immunohistochemical expression of the p53, p21/Waf-1, Rb, p16 and Ki67 proteins in multiple myeloma.

The aim of this study was to investigate the immunohistochemical expression of the proteins p53, Waf-l/p21, Rb, p16 and Ki67 in 38 cases of multiple myelomas (MM) and 4 cases of solitary extramedullary plasmacytomas in relation to the tumor histological grade and stage. In bone marrow (BM) biopsies from MM, overexpression of p53 and p21 proteins, in comparison to plasma cell infiltrates in non-pathological bone marrow, was detected in 13 out of 38 and 21 out of 38 cases, respectively. The combined immunoexpression of p53 and p21 proteins in the 38 cases of MM showed the following patterns: a) p53+/p21+ (13 cases) b) p53-/p21+ (8 cases) and c) p53-/p21- (17 cases).

Docetaxel-induced lymphopenia in patients with solid tumors: a prospective phenotypic analysis.

Background: The quantitative abnormalities of the different peripheral blood lymphocyte subsets during docetaxel administration were prospectively studied.

Methods: Forty-six chemotherapy-naive patients with solid tumors were treated with docetaxel either in a 3 weekly (n = 33) or weekly (n = 13) schedule. Twenty patients with central nervous system (CNS) metastatic disease as the first clinical presentation of cancer and 35 patients with metastatic colorectal carcinoma treated with chemotherapy were enrolled as controls.

Expression of p53, p21/waf1, bcl-2, bax, Rb and Ki67 proteins in Hodgkin's lymphomas.

The aim was to investigate the combined immunoexpression of p53, p21, bcl-2, bax, Rb and Ki67 proteins in Hodgkin's lymphomas (HL) and correlate expression patterns with the histotype and the Epstein-Barr Virus (EBV) status. Paraffin-sections from 56 cases of HL (18 nodular sclerosis and 38 mixed cellularity) and from ten "reactive" lymph nodes were investigated. P53, p21, bcl-2, bax, Rb and Ki67 proteins were detected in Hodgkin and Reed-Sternberg (HRS) cells in 35/56, 56/56, 24/56, 23/56, 56/56 and 56/56 cases of HL, respectively.

Quantitative cytology in ovarian carcinoma ascitic fluids.

Objective: To assess the value of quantitative methods in the differential diagnosis between ovarian carcinoma cells and mesothelial cells in ascitic fluids.

Study Design: Ninety ascitic fluid samples, previously reported as positive for ovarian carcinoma (30 cases), suspicious for malignancy (30) and negative for malignancy, containing only reactive mesothelial cells (30), were retrieved from the files. In each of these specimens the nuclear area, perimeter, roundness and shape coefficient of 100 cells were determined at 630 x magnification.

Docetaxel in combination with carboplatin for the treatment of advanced non-small cell lung carcinoma: a multicentre phase I study.

Docetaxel and carboplatin have shown in vitro and in vivo activity against non-small cell lung cancer (NSCLC). A phase I study was conducted in order to determine the dose-limiting toxicities (DLTs) and the maximum tolerated doses (MTDs) of their combination. Chemotherapy-naïve patients with stage IIIB and IV NSCLC, age<75 years old, performance status (WHO) 0-2, with adequate bone marrow, renal, liver and cardiac function, were treated with docetaxel and carboplatin.

Clinical application of immunological markers as monitoring tests in celiac disease.

The aim of this study was to investigate anti-gliadin (IgA-AGA and IgG-AGA), endomysial (IgA-EmA), and anti-reticulin (Ig-ARA) antibodies for monitoring celiac disease (CD) patients while on gluten-free and gluten-containing diets. Sera from 30 confirmed CD patients (13 boys, 17 girls), 1-24 years old, were examined for antibodies using ELISA (AGA) and Immunofluorescence (EmA, ARA) at 1, 3, 6, 9, and 12 months following institution of gluten-free diet and also at 3 and 6 months after challenge with gluten. One month following the exclusion of gluten from the diet, most antibodies are still positive.

Is there room for general practice in penitentiary institutions: screening and vaccinating high-risk groups against hepatitis.

Objective: The purpose of this study was to determine the prevalence of hepatitis markers in inmates and staff of the Penitentiary of Neapolis on Crete and discuss the role of GPs in identifying and vaccinating susceptible subjects.

Method: Forty-five prisoners and 20 house workers were invited to participate in the study. Hepatitis B (HBV) markers (HBsAg and anti-HBc) and hepatitis C antibodies (anti-HCV) were tested.

Bringing community involvement into a Cretan primary/hospital care center: an evaluation of population habits and attitudes toward health care.

In a small Cretan township hospital combining secondary and primary care, a questionnaire was distributed to a consecutive visitor sample. The questionnaire requested information on the participants' personal smoking and other life habits, perceptions and expectations of the delivery of the health care services, and attitudes toward their own doctors and others who provide various health services. Three hundred and one individuals of both sexes who were 15 years and older participated in the study (participation rate, more than 97%).

Expression of p53, p21/waf, bcl-2, bax, Rb and Ki67 proteins in colorectal adenocarcinomas.

This study investigated the combined immunoexpression of p53, p21, bcl-2, bax, Rb and Ki67 proteins in colorectal adenocarcinomas and correlated expression patterns with tumour stage and grade. Paraffin sections from 98 cases of colorectal adenocarcinomas were stained by immunohistochemistry for p53, p21, bcl-2, bax, Rb and MIB-1 (Ki67) proteins. In addition, 12 cases of colorectal adenomas and normal colorectal mucosa were studied in parallel.

Dose-escalation study of docetaxel in combination with mitoxantrone as first-line treatment in patients with metastatic breast cancer.

Purpose: To define the maximum-tolerated dose (MTD) and the dose-limiting toxicities (DLTs) of docetaxel in combination with mitoxantrone in patients with metastatic breast cancer (MBC).

Patients And Methods: Forty-one chemotherapy-naive patients with MBC (median age, 61 years) were enrolled. Thirty-eight (93%) had performance status (World Health Organization [WHO]) 0, 29 (71%) were postmenopausal, and 21 (51%) had estrogen receptor-negative tumors.

Combination chemotherapy with docetaxel, vinorelbine and cisplatin as first-line treatment of advanced non-small-cell lung cancer: a multicenter phase II study of the Greek Cooperative Group for Lung Cancer.

Vinorelbine, docetaxel and cisplatin have documented single-agent activity in non-small-cell lung cancer (NSCLC); a multicenter phase II trial was initiated in order to evaluate the tolerance and efficacy of their combination. A total of 24 chemotherapy-naive patients with measurable stage IIIB or IV NSCLC and performance status (PS; WHO) 0-2 entered the study. Vinorelbine (20 mg/m2 i.

First-line treatment of advanced nonsmall cell lung carcinoma with docetaxel and vinorelbine.

Background: Docetaxel and vinorelbine are active agents in the treatment of nonsmall cell lung carcinoma (NSCLC). The efficacy and toxicity of this combination was evaluated in a Phase II study in patients with advanced NSCLC.

Methods: Forty-six chemotherapy-naive patients (44 men and 2 women with a median age of 64 years) with NSCLC (11 with Stage IIIB and 35 with Stage IV disease) were entered into the study; the World Health Organization (WHO) performance status was 0, 1, and 2 in 32, 11, and 3 patients, respectively.

Does draining the neck affect morbidity following thyroid surgery?

A prospective randomized study questioning the benefit of neck drainage in thyroid surgery is presented. Two hundred consecutive patients, candidates for elective thyroid surgery, were randomized into Group A (no drain) and Group B (drain). Reoperation for bleeding was necessary for two patients of Group A and for one patient in Group B.

Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 y: the Seven Countries Study.

A follow-up study was conducted to identify the heart disease risk-factor status and dietary changes of surviving elderly subjects in Crete who took part in the Seven Countries Study in 1960. In 1991, data were obtained from 245 of the 686 original male participants (169 of the original 40-49-y age group and 76 men 50-59 y age group). In 1991, the men were 70-79 and 80-89 y old.

Quantitative pathology in uterine smooth muscle tumours: the case for the standard histologic classification criteria.

A number of nuclear morphometric factors (longest and shortest axis, perimeter, area, roundness coefficient) as well as the number of mitoses per 20 high power fields with an x40 objective (mitotic index) and the volume corrected mitotic index (VCMI) have been assessed in 33 uterine smooth muscle tumours (14 leiomyomata, 5 leiomyosarcomata, 9 atypical leiomyomata and 5 tumours of uncertain malignant potential). Multivariate analysis showed the VCMI and nuclear roundness coefficient to be the two most significant prognostic factors achieving, by means of Fisher's linear discriminant function, a high percentage of correct reclassification of the tumours into their respective groups. Furthermore, VCMI was shown to be a more accurate prognostic factor than the simple mitotic index.

Morphologic differences between latent membrane protein-1 (LMP-1)-positive and negative tumour cells in Epstein-Barr virus (EBV)-related childhood Hodgkin's disease. A morphometric study.

The values of five cellular morphometric parameters (longest and shortest cytoplasmic axis, cellular circumference, area and roundness coefficient) were compared between 20 Latent Membrane Protein 1 (LMP-1)-positive and an equal number of LMP-1-negative Reed-Sternberg and Hodgkin (HRS) cells for each of 13 cases of Hodgkin's disease (HD) occurring in children (aged 3-15 years); the presence of Epstein-Barr virus (EBV) encoded EBER mRNAs had previously been detected in all cases using RNA in situ hybridisation (RISH), while the presence of LMP-1 was immunohistochemically detected using the alkaline phosphatase-antialkaline phosphatase (APAAP) method. The longest and shortest axis, circumference and area were larger in LMP-1-positive than in LMP-1 negative HRS cells, while the roundness coefficient of LMP-positive HRS cells was smaller than that of LMP-1 negative cells. All differences were statistically highly significant when univariate (paired comparisons) t-test were used.

Nutrition status of the elderly in Anogia, Crete, Greece.

General health and nutritional status of 167 free-living elderly Greek (aged 65-91 years) were assessed. The most prevalent diseases/symptoms encountered were related to respiratory, gastrointestinal, musculoskeletal and vascular systems (hypertension). Most subjects were socially active.

The effects of a health education intervention program among Cretan adolescents.

Background: An educational intervention program for the prevention of cardiovascular disease among 171 Cretan school students (13- and 14-year-olds) is assessed. Three schools from the province of Agios Vassilios acted as the intervention group while two schools from a neighboring province (Amari) formed the control group.

Methods: Variables measured included: systolic and diastolic blood pressures, body mass index, triceps skinfold thickness, serum total and high-density lipoprotein cholesterol, triglycerides, and smoking habits.

Attitudes towards mental illness in the Athens area: implications for community mental health intervention.

Attitudes towards mental illness were measured in a probability sample of 1574 male and female adults, residents of two boroughs in the greater Athens area before the development of community mental health services in the area. The objective of this study was to identify the components of these attitudes, taking into account the fact that public opinions about mental illness influence the utilization of community mental health services and the level of reintegration of the mentally disabled into society. The instrument used to measure attitudinal dimensions was the Cohen and Struening Opinion about Mental Illness (O.