Greece is a country of intermediate endemicity for hepatitis B and low endemecity for hepatitis C with a downward trend during the last years. In the present study we investigated the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in the region of South-Western Greece and tried to identify the most important risk factors of transmission. This is a unique epidemiological study, as it is the first community based study in the general population of Greece, with a methodological approach based on multi-staged random sampling. The prevalence of HBV infection seems to be decreasing with a 22.6% rate of HBV markers and a 2.1% rate of chronic HBV carriers. We found male sex, old age and intrafamiliar exposure as the major independent risk factors of HBV transmission, while sexual contact, absence of condom prophylaxis and living in rural areas seem to have also a significant impact for HBV infection. No relation was found between HBV transmission and working in health care facilities, pre-existing hospital admissions and history of transfusion. The prevalence of anti-bodies to the HCV was found 0.5%, even lower than the rate reported in the Mediterranean region. Parenteral exposure was the main risk factor for the transmission of HCV infection.

Three cases of deep venous thrombosis following varicella infection are described which were successfully treated with bed rest and anticoagulants. Two of these patients had severe pulmonary manifestations of varicella and the third was complicated by pulmonary embolism. Deep vein thrombosis is an uncommon systemic manifestation of varicella, possibly associated with vascular endothelium wall damage caused by varicella zoster virus infection.

Rituximab as frontline monotherapy in untreated hairy cell leukemia patientsWe have read with great interest the recent article by Leclerc et al. [1] assessing rituximab therapy in hairy cell leukemia, following recent guidelines upon its usage in combination with or without purine analogs in relapsed/refractory disease [2,3]. The authors [1] make an important statement concerning the scarce data upon the use of frontline rituximab as monotherapy, in patients unable to receive other agents due to associated cytopenias, progressive disease, patients who are very elderly, and/or have a poor performance status. Of note in the latter group, attending physicians are not uncommonly met with patients with second malignancy including the solid organ, skin, and lymphoid neoplasms, as shown in large epidemiological studies [4].We hereby would like to report our recent experience with a 70-year-old male patient admitted to our department with shortness of breath in the context of a newly diagnosed pleural effusion (Fig. 1a) for further evaluation. Initial investigation revealed mild pancytopenia (WBC, 2.20 K/μl; poly, 46 %; lymph, 52 %; mono, 2 %; PLT, 135.00 K/μl; Hb, 11.5 g/dl) in the presence of hairy cells in peripheral blood smear, along with several nodular lesions of nonspecific characteristics, approximately~1 cm at the top and posterior segments of the right and left lungs (Fig. 1b). Bone marrow trephine biopsy confirmed 40-50 % lymphocyte infiltration (Fig. 1c, d), the great majority being strongly positive for CD20 (Fig. 1e) and less for CD79a, while 15 % of cells were positive for DBA44 (Fig. 1f). Immunophenotypic analysis of peripheral blood revealed a small CD103(+) population, supporting the diagnosis of B hairy cell leukemia. However, fine needle biopsy staining of pulmonary lesions was positive for TTF-1 and surfactant apoprotein, leading to the diagnosis of synchronous adenocarcinoma of the lung. A PET-CT scan confirmed lesions in the right and left upper lung fields, together with abnormal signal along the right pleura, spleen, and right scapula, along with a newly identified right axillary lymph node. Due to the second malignancy and existing cytopenias, we decided to treat this patient with rituximab alone. He received a weekly course of rituximab (375 mg/m 3 ) for 4 weeks, followed by five monthly courses. Marked increase and complete normalization of blood count were noted after the first 4 cycles and the end of therapy, respectively. A month following the end of the last course, bone marrow trephine biopsy confirmed complete remission of hairy cell leukemia; hence, the patient went on to receive chemotherapy for his lung cancer.Including ours, 12 cases of frontline rituximab monotherapy, the majority of which due to existing neutropenia have been recorded in the literature [1, 5-7] receiving approximately 4-8 weekly infusions. Forty-two percent of patients (5/12) achieved some response [5][6][7], while in 58 % (7/12) of patients, complete remission was noted ranging from 1 to

OBJECT The aim of the study was to investigate whether there are seasonal differences in the occurrence of carcinomatous meningitis (CM), with a greater prevalence of the disease in months with higher temperatures. METHODS The authors searched the records of all patients with a diagnosis of CM from 1998 until 2013 at the University Hospital of Patras, Greece. The date of hospitalization was extracted for each patient. The cases were divided into 2 categories depending on the time of CM diagnosis. Based on the official data regarding the annual temperature distribution in this region, the authors divided the patients into 2 groups. The first group consisted of cases diagnosed with CM from October 15 to April 15 (cold climate and shorter daytime duration), whereas the second group comprised patients diagnosed between April 15 and October 15 (warm climate and longer daytime duration). RESULTS Overall, 44 confirmed cases of CM were found. The most common type of malignancy associated with the development of CM was breast cancer (27 patients), while the second most common tumor was lung carcinoma (11 patients). The median interval between the time of initial cancer diagnosis and CM was 4.5 years. Thirty-one patients were diagnosed with CM during the period between April 15 and October 15, while the remaining 13 patients developed CM between October 15 and April 15, a significant difference (p = 0.01). CONCLUSIONS Significantly more patients developed CM during the warm season of the year. To the authors' knowledge, this is the first study to provide evidence for the potential seasonal variability in CM incidence. However, these results should be validated prospectively in larger cohorts.

Septic thrombophlebitis is characterized by venous thrombosis, inflammation and bacteremia, that can lead to fatal complications such as sepsis, septic emboli and even death. Though most commonly caused by indwelling catheters, it is also related to intravenous drug users (IVDU) especially those who attempt to inject drugs into more proximal and central veins. Lemierre's syndrome, also referred to as post-anginal sepsis or necrobacillosis, is a suppurative thrombophlebitis of the internal jugular vein. Primary infection is associated with oropharyngeal and dental infections and the most common causative organism is Fusobacterium necrophorum. We report a case of Lemierre's syndrome in an IVDU, caused by Fusobacterium necrophorum, which was inoculated at the site of injection, without a history of sore throat or pharyngitis.