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Papavramidis TS, Anagnostis P, Pliakos I, Tzikos G, Chorti A, Kotsa K, Michalopoulos A. The impact of age on quality of life and frailty outcomes after parathyroidectomy in patients with primary hyperparathyroidism. J Endocrinol Invest 2022; 45:797-802. [PMID: 34826129 DOI: 10.1007/s40618-021-01710-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Parathyroidectomy (PTx) improves quality of life (QoL) in patients with primary hyperparathyroidism (PHPT). Whether this effect is modified according to the patients' age is unknown. The aim of this study was to evaluate the impact of age on the effect of PTx on QoL and frailty in patients with PHPT, six months post-PTx. METHODS This was a prospective cohort study, including patients with PHPT, admitted from January 2016 to December 2019, divided into two categories: younger (≤ 65 years old) and older (> 65 years old). QoL was assessed with the Pasieka questionnaire (PAS-Q) two days pre- and six months post-operatively. Frailty was also assessed at the same time intervals, with the Frailty Index (FI). RESULTS One hundred and thirty-four patients (younger group: 96 patients, mean age 50.4 ± 9.8 years; older group: 38 patients, mean age 72.1 ± 4.9 years) were included. PTx resulted in a significant reduction in PAS-Q score in both groups. Notably, a greater reduction in "mood swings", "irritability", "itchy skin" and "feeling thirsty" PAS-Q domains was observed in the younger group. In contrast, a greater decrease in "bone pain", "tiredness", "weakness", "joint pain", "getting off chair" and "headaches" items was observed in the older group. Moreover, PTx led to a decrease in FI only in this group. CONCLUSIONS PTx leads to an improvement in QoL both in older (> 65 years) and younger (≤ 65 years) patients with PHPT, attributed to a differential effect on PAS-Q items. Frailty improves only in the older group.
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Affiliation(s)
- T S Papavramidis
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Minimal Invasive Endocrine Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - P Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - I Pliakos
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Minimal Invasive Endocrine Surgery, Euromedica Kyanous Stavros, Thessaloniki, Greece
| | - G Tzikos
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Chorti
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center, 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - A Michalopoulos
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Paramythiotis D, Goulas P, Moysidis M, Papavramidis T, Michalopoulos A. Bowel intussusception in adults: a report of three interesting cases and current trends for diagnosis and surgical management. Hippokratia 2019; 23:37-41. [PMID: 32256038 PMCID: PMC7124870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Bowel intussusception in adults remains a rare and constant diagnostic challenge for surgeons. It has an incidence of around 2-3 new cases per million per year, and its primary cause is benign or malignant neoplasms of the small bowel and colon. This report aims to outline the importance of high clinical suspicion regarding intussusception in adults presenting with abdominal pain in the emergency department. Case report: This is a retrospective review of three cases of adult ileocecal intussusception that were treated in a single surgical department in three years (2015-2018). All patients underwent right hemicolectomy in keeping with the principles of surgical oncology. Each patient had a different clinical presentation, while, in terms of the underlining pathology, the first had an adenocarcinoma of the ascending colon, the second an adenocarcinoma of the ileocecal valve, and the third one an inflammatory fibroid polyp of the ileocecal valve, also known as Vanek's tumor. CONCLUSION Large bowel intussusception in adults is quite an interesting entity, not only for its rarity but for its non-specific and atypical clinical presentation as well. High suspicion from the clinician's part and availability of a computed tomography scan is the key to diagnosis. It is not unusual for imaging modalities to be unable to identify the cause of the intussusception. Thus, surgery is always the preferred method of treatment, as, more often than not, a neoplasm of the small or the large bowel is the underlining pathology. HIPPOKRATIA 2019, 23(1): 37-41.
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Affiliation(s)
- D Paramythiotis
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - P Goulas
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - M Moysidis
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - T Papavramidis
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - A Michalopoulos
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
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Kosmidis C, Efthimiadis C, Anthimidis G, Vasileiadou K, Koimtzis G, Tzeveleki I, Koletsa T, Prousalidis J, Fahantidis E, Basdanis G, Michalopoulos A, Κesisoglou I. Management of peritoneal hydatid cysts: A fourty-year experience. Heliyon 2018; 4:e00994. [PMID: 30555954 PMCID: PMC6280071 DOI: 10.1016/j.heliyon.2018.e00994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Received: 03/08/2018] [Revised: 09/10/2018] [Accepted: 11/28/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hydatid disease is a global problem. We report our experience with such cases where the dominant cysts were located outside the liver and lungs. In particular, these cysts were found in the peritoneum which is an uncommon location. METHODS Between 1967 and 2007 a total of 34 patients were operated for primary or secondary peritoneal cysts. Most of the patients were asymptomatic or had atypical symptoms. The diagnosis was based on the preoperative history, rupture of the cysts, serology, ultrasound (USS) and computer tomography (CT). Open surgery was the procedure of choice with conservative (18 cysts) and radical (25 cysts) methods. RESULTS The outcome of surgery was good without postoperative mortality or severe morbidity and the recurrence rate was 23.5%. CONCLUSIONS Conservative surgery can provide good results in symptomatic peritoneal cysts. Radical therapy is also ideal but only in properly selected cases. The management of this situation is difficult requiring sound operative experience preferably with a one-stage procedure after an appropriate preoperative preparation.
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Affiliation(s)
- Ch Kosmidis
- Third Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - C. Efthimiadis
- First Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - G. Anthimidis
- First Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - K. Vasileiadou
- First Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - G. Koimtzis
- Third Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - I. Tzeveleki
- First Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - T. Koletsa
- Department of Pathology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J. Prousalidis
- First Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - E. Fahantidis
- First Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - G. Basdanis
- First Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - A. Michalopoulos
- First Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - I. Κesisoglou
- Third Surgical Clinic, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Paramythiotis D, Bangeas P, Karakatsanis A, Karayannopoulou G, Michalopoulos A. Anal canal gastrointestinal stromal tumors - report of a rare case and review of the literature. Hippokratia 2016; 20:313-316. [PMID: 29416307 PMCID: PMC5788233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are considered as rare gastrointestinal tumors, and their location in the anal track is exceptionally unusual. We describe the case of a 28-year-old man with anal GIST, and a review of the cases that have been reported so far in the literature. CASE REPORT The patient was referred for treatment of a gradually enlarging perianal mass. Clinical examination and imaging including orthosigmoidoscopy, transanal ultrasound, and magnetic resonance imaging (MRI) revealed a mass sized 7.5 cm in greatest diameter, in relation with the sphincters, which was excised under general anesthesia. His postoperative course was uneventful and he was discharged on the fourth postoperative day. Pathologic examination revealed characteristics of anal GISTs and further treatment with tyrosine kinase inhibitors was planned. CONCLUSION Anal GISTs usually present with rectal bleeding and pain, and only sixteen cases have been reported in the literature. MRI is the radiologic examination of choice, while optimal treatment is considered surgery in combination with adjuvant therapy. Long-term follow-up is necessary. Hippokratia 2016, 20(4): 313-316.
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Affiliation(s)
- D Paramythiotis
- 1 Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Bangeas
- 1 Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Karakatsanis
- 1 Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Karayannopoulou
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Michalopoulos
- 1 Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Paramythiotis D, Stavrou G, Panagiotou D, Petrakis G, Michalopoulos A. Dermatofibrosarcoma protuberans: a case report and review of the literature. Hippokratia 2016; 20:80-83. [PMID: 27895450 PMCID: PMC5074405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) represents less than 0.1% of all tumors, but it is considered the most common skin sarcoma. Wide local excision (=5 cm) has been largely replaced by Mohs micrographic surgery; however, recurrence is not rare. Description of the case: A 35-year-old man presented with a large tumor on the upper side of his back and underwent local excision with the possible preoperative diagnosis of lipoma. Upon histological examination, the diagnosis of DFSP was made, and the patient underwent wide local excision with skin flap reconstruction and was referred for adjuvant radiotherapy.On twenty months follow-up, no recurrence has been observed. CONCLUSION DFSP is the most common cutaneous sarcoma. It originates in the dermis and tends to infiltrate underlying structures, including muscles, tendons, fascia and bone. In our case, the tumor was confined to the skin and subcutaneous tissue, however, our patient underwent adjuvant radiotherapy to avoid a possible relapse that would infiltrate deeper structures. Long-term follow-up is strongly recommended. Hippokratia 2016, 20(1): 80-83.
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Affiliation(s)
- D Paramythiotis
- 1st Propedeutic Surgical Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Stavrou
- 1st Propedeutic Surgical Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Panagiotou
- 1st Propedeutic Surgical Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Petrakis
- Department of Pathology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Michalopoulos
- 1st Propedeutic Surgical Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Netta S, Papadopoulos V, Apostolidis S, Michalopoulos A. The effect of intraoperative lavage with short chain fatty acids (SCFAs) on rectal anastomosis of rats receiving corticosteroids. Hippokratia 2014; 18:350-354. [PMID: 26052203 PMCID: PMC4453810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Anastomotic failure is one of the most frequent complications in rectal surgery. The present study aims to elucidate the effect of intraoperative lavage with short chain fatty acids (SCFAs) on rectal anastomosis of rats receiving corticosteroids. METHODS Fifty male Wistar rats were divided into five groups. Group A (control group, without lavage and medication), group B (lavage with saline solution and no medication), group C (lavage with SCFAs and no medication), group D (lavage with saline solution and injection of 30mg/kg methylprednisolone 7 days pre-operatively and 4 days post-operatively), group E (lavage with a SCFAs and methylprednisolone). On the 4(th) postoperative day the animals were sacrificed and bursting pressure of the anastomosis, CRP, IL-6 and TNF-a were measured. RESULTS Kruskal-Wallis variance analysis showed statistically significant differences between the groups (p<0.001). The bursting pressure of the anastomosis was lower in groups B and D, while it was higher in group C. TNF-a values displayed differences between group D and groups A, C, E. CONCLUSIONS Intraoperative lavage with SCFAs increases anastomotic strength by increasing the bursting pressure of anastomosis in rats receiving corticosteroid, while lavage with saline solution decreases it. Rectal irrigation with short-chain fatty acids may improve anastomotic healing, especially in patients receiving corticosteroids.
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Affiliation(s)
- S Netta
- 1 Propaedeutic Surgical Department, A.H.E.P.A. University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Papadopoulos
- 1 Propaedeutic Surgical Department, A.H.E.P.A. University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Apostolidis
- Department of Anatomy, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Michalopoulos
- 1 Propaedeutic Surgical Department, A.H.E.P.A. University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Falagas ME, Bliziotis IA, Michalopoulos A, Sermaides G, Papaioannou VE, Nikita D, Choulis N. Effect of a Policy for Restriction of Selected Classes of Antibiotics on Antimicrobial Drug Cost and Resistance. J Chemother 2013; 19:178-84. [PMID: 17434827 DOI: 10.1179/joc.2007.19.2.178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 10/31/2022]
Abstract
Based on the instructions of the National Organization of Pharmaceutical Agents (Greece) from July 1, 2003, quinolones, 3( rd )and 4(th )generation cephalosporins, carbapenems, monobactams, glycopeptides, oxazolidinones, and streptogramins were considered as "restricted" antibiotics that could be used only with the approval of an Infectious Disease specialist. We analyzed the effect of the policy on the consumption and cost of antibiotics as a group and of specific classes, adjusted for the patient load, as well as on the antimicrobial resistance of isolated bacteria. We analyzed 5 trimesters (2 prior and 3 after the implementation of the new policy). A 20% and 16% reduction in adjusted consumption [in daily defined doses (DDDs)] and cost, respectively, of the restricted antibiotics was accomplished during the first trimester after implementation of the new policy. However, this was accompanied by a 36% and 56% increase in adjusted consumption and cost, respectively, of unrestricted antibiotics. A logistic regression model that we performed showed that the new policy had an independent positive effect on the in vitro antimicrobial susceptibility of Pseudomonas aeruginosa (p=0.051) but not of Acinetobacter baumannii and Escherichia coli isolates. Our data suggest that there are considerable limitations to the programs aiming to reduce the consumption of restricted antibiotics through the approval of their use by specialists, at least in some settings.
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Michalopoulos A, Papadopoulos VN, Panidis S, Apostolidis S, Mekras A, Duros V, Ioannidis A, Stavrou G, Basdanis G. Surgical management of rectal prolapse. Tech Coloproctol 2012; 15 Suppl 1:S25-8. [PMID: 21887563 DOI: 10.1007/s10151-011-0747-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Rectal prolapse is uncommon; however, the true incidence is unknown because of underreporting, especially in the elderly population. Full-thickness rectal prolapse, mucosal prolapse and internal prolapse are three different clinical entities, which are often combined and constitute rectal prolapse. The aim of the study is to present our experience in the surgical management of rectal prolapse. METHODS In a 6-year period (2004-2010), 27 patients were surgically treated for rectal prolapse. The majority of patients were women (25 women, two men) and their mean age was 72.36 years. The operations performed were two Delorme's procedures, five STARR (Stapled TransAnal Rectal Resection), 14 Wells procedures, two Wells combined with Thiersch, one Altemeier, one sigmoid resection combined with Wells and two Thiersch. RESULTS An emergency sigmoidostomy was performed on a patient after Wells operation due to obstructive ileus. One death occurred on the 5th postoperative day due to pulmonary embolism. Two recurrences observed 8 months postoperatively, one in a patient after STARR operation and one in a patient after Thiersch technique. The great majority of patients are completely relieved of symptoms. CONCLUSIONS The application of different modalities in the treatment of rectal prolapse is attributed to the fact that cause, degree of prolapse and symptoms, vary from one patient to another. Successful approach depends on many factors, including the status of a patient's anal sphincter muscle before surgery, whether the prolapse is internal or external and the overall condition of the patient.
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Affiliation(s)
- A Michalopoulos
- First Propedeutic Surgical Department, Aristotle's University of Thessaloniki, AHEPA Hospital, T Oikonomidi 21, Kalamaria, 551 31 Thessaloniki, Greece
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Abstract
We present the case of a 45-year-old female patient who was admitted with a history of pelvic pain, constipation, and dysmenorrhea. CT scan and u/s images revealed cholelithiasis, benign nodular hyperplasia of segment IV of the liver and uterine fibromyoma. During laparotomy, firm adhesions between the posterior wall of the uterus and the rectum were found and the incisional biopsy reveals an undifferentiated adenocarcinoma. Then, total resection of the uterus was performed with en block resection of the adherent part of the rectum and part of the posterior wall of the vagina. The final histopathological report showed the presence of uterine fibromyoma, nodular hyperplasia of the liver and rectal endometriosis without any sign of malignancy. The patient after 5 years of follow up remains healthy. Rectal endometriosis represents an uncommon localization of pelvic endometriosis where the symptoms and clinical findings are non-specific making the definitive preoperative diagnosis difficult. Endometriosis should be included in the differential diagnosis of chronic pelvic pain in combination with defecation disorders in female patients of reproductive age.
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Affiliation(s)
- V N Papadopoulos
- 1st Propedeutic Surgical Department, Aristotle's University of Thessaloniki, AHEPA Hospital, T Oikonomidi 21, 551 31 Thessaloniki, Kalamaria, Greece.
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Papadopoulos VN, Michalopoulos A, Apostolidis S, Paramythiotis D, Ioannidis A, Mekras A, Panidis S, Stavrou G, Basdanis G. Surgical management of colorectal injuries: colostomy or primary repair? Tech Coloproctol 2011; 15 Suppl 1:S63-6. [DOI: 10.1007/s10151-011-0734-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Alexiou VG, Michalopoulos A, Makris GC, Peppas G, Samonis G, Falagas ME. Multi-drug-resistant gram-negative bacterial infection in surgical patients hospitalized in the ICU: a cohort study. Eur J Clin Microbiol Infect Dis 2011; 31:557-66. [PMID: 21796346 DOI: 10.1007/s10096-011-1347-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 07/02/2011] [Indexed: 11/29/2022]
Abstract
We sought to identify risk factors for postoperative infections, caused by multi-drug-resistant gram-negative bacteria (MDR-GNB) in surgical patients. This was a retrospective cohort study among patients hospitalized in the intensive care unit (ICU) for more than 5 days, following general surgical operations. Comparison of patients who developed infection caused by MDR-GNB with the remainder of the cohort showed that every minute of operative time, use of special treatments during hospitalization (antineoplastic, immunosuppressive or immunomodulating therapies), every day of metronidazole, and every day of carbapenems use, increased patients' odds to acquire an infection caused by MDR-GNB by 0.7%, 8.9 times, 9%, and 9%, respectively [OR (95% CI): 1.007 (1.003-1.011), p = 0.001; 8.9 (1.8-17.3), p = 0.004; 1.09 (1.04-1.18), p = 0.039; 1.09 (1.01-1.18), p = 0.023, respectively]. The above were adjusted in the multivariable analysis for the confounder of time distribution of infections caused by MDR-GNB. Finally, the secondary comparison, with patients that did not develop any infection, showed that patients who had received antibiotics, within 3 months prior to admission, had 3.8 times higher odds to acquire an infection caused by MDR-GNB [OR (95% CI): 3.8 (1.07-13.2), p = 0.002]. This study depicts certain, potentially modifiable, risk factors for postoperative infections in patients hospitalized in the ICU for more than 5 days.
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Affiliation(s)
- V G Alexiou
- Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 15 123, Marousi, Greece
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Falagas ME, Kouranos VD, Michalopoulos A, Rodopoulou SP, Batsiou MA, Karageorgopoulos DE. Comparison of the distribution of citations received by articles published in high, moderate, and low impact factor journals in clinical medicine. Intern Med J 2011; 40:587-91. [PMID: 20718883 DOI: 10.1111/j.1445-5994.2010.02247.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Whether the journal impact factor (JIF) indicator reflects the number of citations to an average article of a journal in different subject categories is controversial. We sought to further investigate this issue in general and internal medicine journals. METHODS We selected to evaluate three journals of the above subject category, in each of three different JIF levels (high: 15.5-28.6, moderate: 4.4-4.9 and low: 1.6). Using the Scopus database, we retrieved the original research articles (after detailed screening) and review articles (as classified by Scopus) that were published in the selected journals in 2005 along with the number of citations they received in 2006 and 2007. We pooled the citations for articles of the same type in journals with the same JIF level into distinct variables. RESULTS There was no marked association between the distribution of citations per article published in general medical journals and their JIF. All distributions studied were skewed to the right (higher number of citations). Specifically, 16-22% of the original research articles accounted for 50% of the total citations to this type of article for all three categories of studied journals; 34-37% of original research articles accounted for 75% of citations. The respective values for review articles were 12-18% and 29-39%. CONCLUSION The distribution of citations received by articles published in high, moderate and low impact factor journals in clinical medicine seems similar. The JIF is not an accurate indicator of the citations the average article receives; articles published in low impact factor journals can still be highly cited and vice versa.
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Affiliation(s)
- M E Falagas
- Department of Medicine, Alfa Institute of Biomedical Sciences, Athens, Greece.
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Kwa AL, Falagas ME, Michalopoulos A, Tam VH. Benefits of Aerosolized Colistin for Ventilator-Associated Pneumonia: Absence of Proof Versus Proof of Absence? Clin Infect Dis 2011; 52:1278-9; author reply 1279-80. [DOI: 10.1093/cid/cir134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Michalopoulos A, Papadopoulos V, Paramythiotis D, Papavramidis T, Douros V, Netta S, Mekras A, Apostolidis S. Colonic cancer in a patient with intestinal malrotation: a case report. Tech Coloproctol 2011; 14 Suppl 1:S65-6. [PMID: 20683743 DOI: 10.1007/s10151-010-0632-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 11/28/2022]
Abstract
We present a case of a 76-year-old patient with intestinal malrotation, with incomplete rotation of the small intestine and abnormal positioning of the duodenum and superior mesenteric vessels over the transverse colon. Furthermore, the patient suffered of a concomitant cancer of the ascending colon.
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Affiliation(s)
- A Michalopoulos
- 1st Propedeutic Surgical Clinic, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, T.Ikonimidi 21, Kalamaria, 551 31 Thessaloniki, Greece
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Karamanlis E, Michalopoulos A, Papadopoulos V, Mekras A, Panagiotou D, Ioannidis A, Basdanis G, Fahantidis E. Prospective clinical trial comparing sphincterotomy, nitroglycerin ointment and xylocaine/lactulose combination for the treatment of anal fissure. Tech Coloproctol 2011; 14 Suppl 1:S21-3. [PMID: 20683754 DOI: 10.1007/s10151-010-0610-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study is to compare the ability of three treatments in patients with anal fissure, sphincterotomy, nitroglycerin ointment and combination of gel xylocaine and lactulose. METHODS Ninety adults divided in three groups of 30 patients each group, received one of the three treatments in a 3-year interval (2007-2009) and the follow-up was for 2 months. Group A received nitroglycerin ointment, Group B underwent sphincterotomy and Group C received gel xylocaine and lactulose. RESULTS Concerning pain, after treatment 60% of patients in Group A did not complain of pain, 20% had transient pain, another 10% moderate pain and the remaining 10% had severe pain. In Group B, 95% of the patients had no pain and only 5% had mild, transient pain. In Group C 60% of the patients had moderate pain and the other 40% suffered from severe pain. Concerning fissure healing, in 60% of the patients of Group A, the fissure was healed. In Group B fissure healed in 93.3% and in Group C only in 16.6% of the patients. CONCLUSION The "gold standard" for anal fissure treatment is the lateral internal sphincterotomy and that each one of the three methods has its advantages and disadvantages.
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Affiliation(s)
- E Karamanlis
- 1st Propedeutic Surgical Clinic, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Netta S, Michalopoulos A, Apostolidis S, Paramythiotis D, Papavramidis T, Papadopoulos V, Tziris N. Enhancement of colonic anastomotic strength in rats by short-chain fatty acids. Tech Coloproctol 2011; 14 Suppl 1:S53-5. [PMID: 20683753 DOI: 10.1007/s10151-010-0611-2] [Citation(s) in RCA: 1] [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: 10/19/2022]
Abstract
BACKGROUND The present study is aiming at elucidating the effect of intraoperative lavage with short-chain fatty acids (SCFAs) on colonic anastomosis in rats. METHODS Forty male Wistar rats were randomized into four groups (10 rats each). After resection of a segment of transverse colon, an end-to-end anastomosis was performed. In the 1st group, no intraoperative large bowel lavage was performed; in the 2nd, a lavage with normal saline solution; in the 3rd, the animals received a diet rich in SCFAs pre- and postoperatively, and a lavage with normal saline was performed; and in the 4th group, an intraoperative lavage with SCFAs was carried out. On the 4th postoperative day, the animals were sacrificed. Septic complications, adhesions and anastomoses were graded macroscopically and histologically, and bursting pressure of the anastomoses, CRP, IL-6 and TNF-a was measured. RESULTS Fewer septic complications (abscesses and minimal ruptures) and adhesions were observed in the 4th group with the intraoperative lavage with SCFAs. The bursting pressure also, in the same group, was higher (73.3 mmHg), followed by the 1st group (67.1 mmHg). CONCLUSION Intraoperative lavage with SCFAs increases the bursting pressure of colonic anastomoses, while lavage with saline solution decreases it, in comparison to the group without lavage.
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Affiliation(s)
- S Netta
- 1st Propedeutic Surgical Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, T.Ikonimidi 21, 551 31 Kalamaria, Thessaloniki, Greece
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Karageorgopoulos DE, Vouloumanou EK, Ntziora F, Michalopoulos A, Rafailidis PI, Falagas ME. -D-Glucan Assay for the Diagnosis of Invasive Fungal Infections: A Meta-analysis. Clin Infect Dis 2011; 52:750-70. [DOI: 10.1093/cid/ciq206] [Citation(s) in RCA: 400] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Michalopoulos A, Landeweerd L, Van der Werf-Kulichova Z, Puylaert PGB, Osseweijer P. Contrasts and synergies in different biofuel reports. Interface Focus 2011; 1:248-54. [PMID: 22482031 DOI: 10.1098/rsfs.2010.0034] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 01/10/2011] [Indexed: 11/12/2022] Open
Abstract
The societal debate on biofuels is characterised by increased complexity. This can hinder the effective governance of the field. This paper attempts a quantitative bird's eye meta-analysis of this complexity by mapping different stakeholder perspectives and expected outcomes as seen in the secondary literature on biofuels, along the lines of the People-Planet-Profit framework. Our analysis illustrates the tension between stated and actual drivers of large scale biofuel development, especially for first generation biofuels. Although environmental (Planet) aspects have dominated the biofuel debate, their overall assessment is mostly negative with regard to first generation biofuels. By contrast, economic (Profit) aspects are the only ones that are assessed positively with regard to first generation biofuels. Furthermore, positive and negative assessments of biofuel development are strongly influenced by the differences in focus between different stakeholder clusters. Stakeholders who appear generally supportive to biofuel development (industry) focus relatively more on aspects that are generally assessed as positive (Profit). By contrast, non-supportive stakeholders (NGO's) tend to focus mainly on aspects that are generally assessed as negative (Planet). Moreover, our analysis of reference lists revealed few citations of primary scientific data, and also that intergovernmental organizations produce the most influential publications in the debate. The surprising lack of listed references to scientific (primary) data reveals a need to assess in which arena the transition of scientific data towards secondary publications takes place, and how one can measure its quality. This work should be understood as a first effort to take some control over a complex and contradictory number of publications, and to allow the effective governance of the field through the identification of areas of overlapping consensus and persisting controversy, without reverting to claims on technical detail.
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Affiliation(s)
- A Michalopoulos
- Kluyver Centre for Genomics of Industrial Fermentation, Delft University of Technology, Section of Biotechnology and Society, Delft , The Netherlands
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Adams NG, Adekambi T, Afeltra J, Aguado J, Aires de Sousa M, Akiyoshi K, Al Hasan M, Ala-Kokko T, Albert M, Alfandari S, Allen D, Allerberger F, Almyroudis N, Alp E, Amin R, Anderson-Berry A, Andes DR, Andremont A, Andreu A, Angelakis M, Antachopoulos C, Antoniadou A, Arabatzis M, Arlet G, Arnez M, Arnold C, Asensio A, Asseray N, Ausiello C, Avni T, Ayling R, Baddour L, Baguelin M, Bányai K, Barbour A, Basco LK, Bauer D, Bayston R, Beall B, Becker K, Behr M, Bejon P, Belliot G, Benito-Fernandez J, Benjamin D, Benschop K, Berencsi G, Bergeron MG, Bernard K, Berner R, Beyersmann J, Bille J, Bizzini A, Bjarnsholt T, Blanc D, Blanco J, Blot S, Bohnert J, Boillat N, Bonomo R, Bonten M, Bordon JM, Borel N, Boschiroli ML, Bosilkovski M, Bosso JA, Botelho-Nevers E, Bou G, Bretagne S, Brouqui P, Brun-Buisson C, Brunetto M, Bucher H, Buchheidt D, Buckling A, Bulpa P, Cambau E, Canducci F, Cantón R, Capobianchi M, Carattoli A, Carcopino X, Cardona-Castro N, Carling PC, Carrat F, Castilla J, Castilletti C, Cavaco L, Cavallo R, Ceccherini-Silberstein F, Centrón D, Chappuis F, Charrel R, Chen M, Chevaliez S, Chezzi C, Chomel B, Chowers M, Chryssanthou E, Ciammaruconi A, Ciccozzi M, Cid J, Ciofu O, Cisneros D, Ciufolini MG, Clark C, Clarke SC, Clayton R, Clementi M, Clemons K, Cloeckaert A, Cloud J, Coenye T, Cohen Bacri S, Cohen R, Coia J, Colombo A, Colson P, Concerse P, Cordonnier C, Cormican M, Cornaglia G, Cornely O, Costa S, Cots F, Craxi A, Creti R, Crnich C, Cuenca Estrella M, Cusi MG, d'Ettorre G, da Cruz Lamas C, Daikos G, Dannaoui E, De Barbeyrac B, De Grazia S, de Jager C, de Lamballerie X, de Marco F, del Palacio A, Delpeyroux F, Denamur E, Denis O, Depaquit J, Deplano A, Desenclos JC, Desjeux P, Deutch S, Di Luca D, Dianzani F, Diep B, Diestra K, Dignani C, Dimopoulos G, Divizia M, Doi Y, Dornbusch HJ, Dotis J, Drancourt M, Drevinek P, Dromer F, Dryden M, Dubreuil L, Dubus JC, Dumitrescu O, Dumke R, DuPont H, Edelstein M, Eggimann P, Eis-Huebinger AM, El Atrouni WI, Entenza J, Ergonul O, Espinel-Ingroff A, Esteban J, Etienne J, Fan XG, Fenollar F, Ferrante P, Ferrieri P, Ferry T, Feuchtinger T, Finegold S, Fingerle V, Fitch M, Fitzgerald R, Flori P, Fluit A, Fontana R, Fournier PE, François M, Francois P, Freedman DO, Friedrich A, Gallego L, Gallinella G, Gangneux JP, Gannon V, Garbarg-Chenon A, Garbino J, Garnacho-Montero J, Gatermann S, Gautret P, Gentile G, Gerlich W, Ghannoum M, Ghebremedhin B, Ghigo E, Giamarellos-Bourboulis E, Girgis R, Giske C, Glupczynski Y, Gnarpe J, Gomez-Barrena E, Gorwitz RJ, Gosselin R, Goubau P, Gould E, Gradel K, Gray J, Gregson D, Greub G, Grijalva CG, Groll A, Groschup M, Gutiérrez J, Hackam DG, Hall WA, Hallett R, Hansen S, Harbarth S, Harf-Monteil C, Hasanjani RMR, Hasler P, Hatchette T, Hauser P, He Q, Hedges A, Helbig J, Hennequin C, Herrmann B, Hezode C, Higgins P, Hoesli I, Hoiby N, Hope W, Houvinen P, Hsu LY, Huard R, Humphreys H, Icardi M, Imoehl M, Ivanova K, Iwamoto T, Izopet J, Jackson Y, Jacobsen K, Jang TN, Jasir A, Jaulhac B, Jaureguy F, Jefferies JM, Jehl F, Johnstone J, Joly-Guillou ML, Jonas M, Jones M, Joukhadar C, Kahl B, Kaier K, Kaiser L, Kato H, Katragkou A, Kearns A, Kern W, Kerr K, Kessin R, Kibbler C, Kimberlin D, Kittang B, Klaassen C, Kluytmans J, Ko WC, Koh WJ, Kostrzewa M, Kourbeti I, Krause R, Krcmery V, Krizova P, Kuijper E, Kullberg BJ, Kumar G, Kunin CM, La Scola B, Lagging M, Lagrou K, Lamagni T, Landini P, Landman D, Larsen A, Lass-Floerl C, Laupland K, Lavigne JP, Leblebicioglu H, Lee B, Lee CH, Leggat P, Lehours P, Leibovici L, Leon L, Leonard N, Leone M, Lescure X, Lesprit P, Levy PY, Lew D, Lexau CA, Li SY, Li W, Lieberman D, Lina B, Lina G, Lindsay JA, Livermore D, Lorente L, Lortholary O, Lucet JC, Lund B, Lütticken R, MacLeod C, Madhi S, Maertens J, Maggi F, Maiden M, Maillard JY, Maira-Litran T, Maltezou H, Manian FA, Mantadakis E, Maragakis L, Marcelin AG, Marchaim D, Marchetti O, Marcos M, Markotic A, Martina B, Martínez J, Martinez JL, Marty F, Maurin M, McGee L, Mediannikov O, Meersseman W, Megraud F, Meletiadis J, Mellmann A, Meyer E, Meyer W, Meylan P, Michalopoulos A, Micol R, Midulla F, Mikami Y, Miller RF, Miragaia M, Miriagou V, Mitchell TJ, Miyakis S, Mokrousov I, Monecke S, Mönkemüller K, Monno L, Monod M, Morales G, Moriarty F, Morosini I, Mortensen E, Mubarak K, Mueller B, Mühlemann K, Muñoz Bellido JL, Murray P, Muscillo M, Mylotte J, Naessens A, Nagy E, Nahm MH, Nassif X, Navarro D, Navarro F, Neofytos D, Nes I, Ní Eidhin D, Nicolle L, Niederman MS, Nigro G, Nimmo G, Nordmann P, Nougairède A, Novais A, Nygard K, Oliveira D, Orth D, Ortiz JR, Osherov N, Österblad M, Ostrosky-Zeichner L, Pagano L, Palamara AT, Pallares R, Panagopoulou P, Pandey P, Panepinto J, Pappas G, Parkins M, Parola P, Pasqualotto A, Pasteran F, Paul M, Pawlotsky JM, Peeters M, Peixe L, Pepin J, Peralta G, Pereyre S, Perfect JR, Petinaki E, Petric M, Pettigrew M, Pfaller M, Philipp M, Phillips G, Pichichero M, Pierangeli A, Pierard D, Pigrau C, Pilishvili T, Pinto F, Pistello M, Pitout J, Poirel L, Poli G, Poppert S, Posfay-Barbe K, Pothier P, Poxton I, Poyart C, Pozzetto B, Pujol M, Pulcini C, Punyadeera C, Ramirez M, Ranque S, Raoult D, Rasigade JP, Re MC, Reilly JS, Reinert R, Renaud B, Rice L, Rich S, Richet H, Rigouts L, Riva E, Rizzo C, Robotham J, Rodicio MR, Rodriguez J, Rodriguez-Bano J, Rogier C, Roilides E, Rolain JM, Rooijakkers S, Rooney P, Rossi F, Rotimi V, Rottman M, Roux V, Ruhe J, Russo G, Sadowy E, Sagel U, Said SI, Saijo M, Sak B, Sa-Leao R, Sanders EAM, Sanguinetti M, Sarrazin C, Savelkoul P, Scheifele D, Schmidt WP, Schønheyder H, Schönrich G, Schrenzel J, Schubert S, Schwarz K, Schwarz S, Sefton A, Segondy M, Seifert H, Seng P, Senneville E, Sexton D, Shafer RW, Shalit I, Shankar N, Shata TM, Shields J, Sibley C, Sicinschi L, Siljander T, Simitsopoulou M, Simoons-Smit AM, Sissoko D, Sjögren J, Skiada A, Skoczynska A, Skov R, Slack M, Sogaard M, Sola C, Soriano A, Sotto A, Sougakoff W, Sougakoff W, Souli M, Spelberg B, Spelman D, Spiliopoulou I, Springer B, Stefani S, Stein A, Steinbach WJ, Steinbakk M, Strakova L, Strenger V, Sturm P, Sullivan P, Sutton D, Symmons D, Tacconelli E, Tamalet C, Tang JW, Tang YW, Tattevin P, Thibault V, Thomsen RW, Thuny F, Tong S, Torres C, Townsend R, Tristan A, Trouillet JL, Tsai HC, Tsitsopoulos P, Tuerlinckx D, Tulkens P, Tumbarello M, Tureen J, Turnidge JD, Turriziani O, Tutuian R, Uçkay I, Upton M, Vabret A, Vamvakas EC, van den Boom D, Van Eldere J, van Leeuwen W, van Strijp J, Van Veen S, Vandamme P, Vandenesch F, Vayssier M, Velin D, Venditti M, Venter M, Venuti A, Vergnaud G, Verheij T, Verhofstede C, Viscoli C, Vizza CD, Vogel U, Waller A, Wang YF, Warn P, Warris A, Wauters G, Weidmann M, Weill FX, Weinberger M, Welch D, Wellinghausen N, Wheat J, Widmer A, Wild F, Willems R, Willinger B, Winstanley C, Witte W, Wolff M, Wong F, Wootton M, Wyllie D, Xu W, Yamamoto S, Yaron S, Yildirim I, Zaoutis T, Zazzi M, Zbinden R, Zehender GG, Zemlickova H, Zerbini ML, Zhang L, Zhang Y, Zhao YD, Zhu Z, Zimmerli W. ACKNOWLEDGEMENT OF REVIEWERS. Clin Microbiol Infect 2011. [DOI: 10.1111/j.1469-0691.2010.03428.x] [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: 11/28/2022]
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Falagas ME, Cholevas NV, Kapaskelis AM, Vouloumanou EK, Michalopoulos A, Rafailidis PI. Epidemiological aspects of 2009 H1N1 influenza: the accumulating experience from the Northern Hemisphere. Eur J Clin Microbiol Infect Dis 2010; 29:1327-47. [DOI: 10.1007/s10096-010-1002-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 06/10/2010] [Indexed: 11/29/2022]
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Michalopoulos A, Virtzili S, Rafailidis P, Chalevelakis G, Damala M, Falagas M. Intravenous fosfomycin for the treatment of nosocomial infections caused by carbapenem-resistant Klebsiella pneumoniae in critically ill patients: a prospective evaluation. Clin Microbiol Infect 2010; 16:184-6. [DOI: 10.1111/j.1469-0691.2009.02921.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Papavramidis TS, Potsi S, Paramythiotis D, Michalopoulos A, Papadopoulos VN, Douros V, Pantoleon A, Foutzila-Kalogera A, Ekonomou I, Harlaftis N. Gallstone obstructive ileus 3 years post-cholecystectomy to a patient with an old ileoileal anastomosis. J Korean Med Sci 2009; 24:1216-9. [PMID: 19949687 PMCID: PMC2775879 DOI: 10.3346/jkms.2009.24.6.1216] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 06/22/2008] [Indexed: 12/25/2022] Open
Abstract
The present case is one of gallstone obstructive ileus due to gallstones 3 yr after laparoscopic cholecystectomy. It is interesting because of the sex of the patient, the fact that ileus occurred 3 yr after cholecystectomy and that the localization of the obstruction was an old side-to-side ileoileal anastomosis due to a diverticulectomy following intussusception of Meckels' diverticulum at the age of 3.
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Affiliation(s)
- T S Papavramidis
- 1st Propedeutic Surgical Clinic, Aristotle University of Thessaloniki, A.H.E.P.A. University Hospital, Thessaloniki, Greece.
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Korbila IP, Michalopoulos A, Rafailidis PI, Nikita D, Samonis G, Falagas ME. Inhaled colistin as adjunctive therapy to intravenous colistin for the treatment of microbiologically documented ventilator-associated pneumonia: a comparative cohort study. Clin Microbiol Infect 2009; 16:1230-6. [PMID: 19732088 DOI: 10.1111/j.1469-0691.2009.03040.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ventilator-associated pneumonia (VAP) as a result of multidrug-resistant Gram-negative bacteria has contributed to the revival of the use of intravenous (i.v.) colistin. However, the additional administration of inhaled colistin for VAP is controversial. We performed a retrospective cohort study of patients with microbiologically documented VAP who received i.v. colistin with or without inhaled colistin. Seventy-eight patients with VAP received i.v. plus inhaled colistin, whereas 43 patients received i.v. colistin alone. The mean +/- SD daily dosage of i.v. colistin was 7.0 +/- 2.4 and 6.4 +/- 2.3 million international units (IU), respectively (p 0.13); the average daily dosage of inhaled colistin was 2.1 +/- 0.9 million IU. The outcome of infection was cure for 62/78 (79.5%) patients who received i.v. plus inhaled colistin vs. 26/43 (60.5%) patients who received i.v. colistin alone (p 0.025); all-cause in-hospital mortality was 31/78 (39.7%) vs. 19/43 (44.2%), respectively (p 0.63); all-cause intensive care unit (ICU) mortality was 28/78 (35.9%) vs. 17/43 (39.5%), respectively (p 0.92). The use of inhaled colistin was independently associated with the cure of VAP in a multivariable analysis (OR 2.53, 95% CI 1.11-5.76). Independent predictors of mortality were a higher APACHE II score (OR 1.12, 95% CI 1.04-1.20), presence of malignancy (OR 4.11, 95% CI 1.18-14.23) and lower daily dosage of i.v. colistin (OR 0.81, 95% CI 0.68-0.96). The outcome of VAP was better in patients who received inhaled colistin with i.v. colistin than those who received i.v. colistin alone. There was no difference in all-cause in-hospital and ICU mortality between the two groups. Randomized controlled trials are needed to evaluate further the role of inhaled colistin in VAP.
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Affiliation(s)
- I P Korbila
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
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Vardakas K, Michalopoulos A, Kiriakidou K, Siampli E, Samonis G, Falagas M. Candidaemia: incidence, risk factors, characteristics and outcomes in immunocompetent critically ill patients. Clin Microbiol Infect 2009; 15:289-92. [DOI: 10.1111/j.1469-0691.2008.02653.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Apostolidis S, Papavramidis T, Michalopoulos A, Papadopoulos V, Paramythiotis D, Harlaftis N. Groin swelling, the anatomic way out of abdominal haematomas: a case report and explicative literature review. Acta Chir Belg 2008; 108:251-3. [PMID: 18557154 DOI: 10.1080/00015458.2008.11680214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This case report concerns a previously healthy thirty-five-year-old female with complaints of inguinal hernia that ultimately proved to be a retroperitoneal haematoma. The patient suffered from a car accident 5 months before admission and was hospitalized. During her prior hospitalization, explorative laparotomy revealed a haematoma of the mesentery. The haematoma was treated conservatively, with fluid resuscitation and rest. During her second admission, MRI of the inguinal region revealed localized haematoma. During inguinal exploration, a fluid-filled bluish indirect hernia sac was identified and found to be contoured by free-flowing, non-clotting blood. The postoperative course was uneventful, and the patient was discharged six days following surgery.
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Affiliation(s)
- S. Apostolidis
- 1st Propedeutic Surgical Department,A.H.E.P.A University Hospital,Aristotle’s University of Thessaloniki, Thessaloniki, Greece
| | - T.S. Papavramidis
- 1st Propedeutic Surgical Department,A.H.E.P.A University Hospital,Aristotle’s University of Thessaloniki, Thessaloniki, Greece
| | - A. Michalopoulos
- 1st Propedeutic Surgical Department,A.H.E.P.A University Hospital,Aristotle’s University of Thessaloniki, Thessaloniki, Greece
| | - V.N. Papadopoulos
- 1st Propedeutic Surgical Department,A.H.E.P.A University Hospital,Aristotle’s University of Thessaloniki, Thessaloniki, Greece
| | - D. Paramythiotis
- 1st Propedeutic Surgical Department,A.H.E.P.A University Hospital,Aristotle’s University of Thessaloniki, Thessaloniki, Greece
| | - N. Harlaftis
- 1st Propedeutic Surgical Department,A.H.E.P.A University Hospital,Aristotle’s University of Thessaloniki, Thessaloniki, Greece
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Paramythiotis D, Papadopoulos VN, Michalopoulos A, Papavramidis TS, Berovalis P, Harlaftis N. Acute pneumomediastinum secondary to hydrogen peroxide therapy of upper right limb wound. Eur Surg 2007. [DOI: 10.1007/s10353-007-0372-y] [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: 11/24/2022]
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Falagas ME, Pappas VD, Michalopoulos A. Gangrenous, Hemorrhagic, Bullous Cellulitis Associated with Pseudomonas aeruginosa in a Patient with Waldenström's Macroglobulinemia. Infection 2007; 35:370-3. [PMID: 17721738 DOI: 10.1007/s15010-007-6257-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/21/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with Waldenström's macroglobulinemia may manifest several types of skin lesions. We present our experience with a patient with the disease that adds to the literature on the topic. CASE DESCRIPTION A 57-year-old man with history of multiple sclerosis and Waldenström's macroglobulinemia was admitted to the intensive care unit in shock. His family members reported that the patient had complained of fever and the gradual development of gangrenous, hemorrhagic, bullous cellulitis lesions on the abdomen and lower extremities for 7 days prior to his admission to the hospital. Pseudomonas aeruginosa was isolated from fluid specimens collected from the cutaneous lesions. Appropriate antimicrobial treatment including continuous intravenous administration of meropenem (6 g every 24 h) led to the cure of the infection. CONCLUSIONS We postulate that the underlying Waldenström's macroglobulinemia contributed to the pathophysiology of the development of the rare skin manifestations of the infection observed in our patient.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, Marousi, 151 23, Athens, Greece.
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Christodoulou C, Rizos M, Galani E, Rellos K, Skarlos DV, Michalopoulos A. Performance status (PS): a simple predictor of short-term outcome of cancer patients with solid tumors admitted to the intensive care unit (ICU). Anticancer Res 2007; 27:2945-8. [PMID: 17695475] [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: 05/16/2023]
Abstract
BACKGROUND Admission of cancer patients with serious medical complications to the Intensive Care Unit (ICU) remains controversial. The aim of this study was to examine the 30-day all-cause mortality in cancer patients with solid tumors admitted to the ICU and to identify factors predicting 30-day mortality. PATIENTS AND METHODS A retrospective study was conducted in 69 consecutive cancer patients with solid tumors admitted to the ICU of a 400-bed general hospital in Greece, between October 2001 and October 2005. Demographics, ECOG performance status (PS) prior to hospitalization, stage of cancer, metastases, number of metastatic sites, prior chemotherapy, primary site of tumor, APACHE II score on ICU admission, development of ICU acquired infection, sepsis, multiple organ failure (MOF), need for mechanical ventilation (MV), length of ICU stay, hospital stay and 30-day mortality were examined. RESULTS The observed 30-day hospital mortality rate was 66.6% (n=46) with most deaths (n=32) occurring in the ICU. Univariate negative predictors of 30-day mortality were PS 3-4 (p=0.03), APACHE II score (p=0.001), MOF (p=0.001) and need for MV (p=0.001). Only PS 3-4 was an independent predictor in multivariate analysis (p=0.02). CONCLUSION ECOG PS 3-4 prior to hospitalization was found to be a simple negative predictor of short-term outcome of cancer patients with solid tumors admitted to the ICU.
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Affiliation(s)
- C Christodoulou
- Second Oncology Department, "Henry Dunant" Hospital, Athens, Greece.
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Falagas ME, Rafailidis PI, Kasiakou SK, Hatzopoulou P, Michalopoulos A. Effectiveness and nephrotoxicity of colistin monotherapy vs. colistin–meropenem combination therapy for multidrug-resistant Gram-negative bacterial infections. Clin Microbiol Infect 2006; 12:1227-30. [PMID: 17121631 DOI: 10.1111/j.1469-0691.2006.01559.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [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: 11/29/2022]
Abstract
A retrospective cohort study evaluated the effectiveness and nephrotoxicity of intravenous colistin monotherapy vs. colistin-meropenem combination therapy for patients with multidrug-resistant Gram-negative bacterial infections. Fourteen patients received intravenous colistin monotherapy and 57 received colistin-meropenem. No significant differences were found concerning clinical response of the infection (12/14 (85.7%) vs. 39/57 (68.4%), p 0.32) and development of nephrotoxicity (0/14 (0%) vs. 4/57 (7%), p 0.58). A favourable association was revealed between survival and treatment with colistin monotherapy compared to colistin-meropenem (0/14 (0%) vs. 21/57 (36.8%) deaths, p 0.007), even after adjusting for the variables for which significant differences were found.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
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Batzios S, Michalopoulos A, Kaklamanis L, Stathopoulos J, Christopoulou M, Koutantos J, Stathopoulos GP. Angiosarcoma of the heart: case report and review of the literature. Anticancer Res 2006; 26:4837-42. [PMID: 17214349] [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: 05/13/2023]
Abstract
BACKGROUND Primary angiosarcoma of the heart is an extremely rare malignant disease. PATIENTS AND METHODS A 32-year-old female with primary angiosarcoma of the heart at an advanced stage with lung and bone metastases is presented. The tumor showed extensive expression of c-erb-B2 and a moderate expression of c-kit. Chemotherapy (cisplatin, epirubicin and ifosfamide) was administered. Herceptin as well as glivec were added to the above combination. RESULTS There was a good partial response and the lung deposits almost disappeared. The duration of response was 6 months. CONCLUSION This case of angiosarcoma of the heart is presented because of the extreme rarity of this disease, and its responsiveness to chemotherapy in combination with imatinib and herceptin.
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Affiliation(s)
- S Batzios
- First Oncology Clinic, Errikos Dunant Hospital, Athens, Greece
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Michalopoulos A, Papadopoulos V, Apostolidis S, Papavramidis T, Paramythiotis D, Berovalis P. A rare case of pancreatic pseudocyst masquerading as hydrocele. Acta Gastroenterol Belg 2006; 69:424. [PMID: 17343088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Michalopoulos A, Prapas S, Falagas ME. The incidence of adult respiratory distress syndrome in patients undergoing off-pump coronary artery bypass grafting surgery. Eur J Anaesthesiol 2006; 23:80. [PMID: 16390572 DOI: 10.1017/s0265021505211821] [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] [Accepted: 09/09/2005] [Indexed: 11/07/2022]
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Papadopoulos V, Michalopoulos A, Basdanis G, Papapolychroniadis K, Paramythiotis D, Fotiadis P, Berovalis P, Harlaftis N. Synchronous and metachronous colorectal carcinoma. Tech Coloproctol 2005; 8 Suppl 1:s97-s100. [PMID: 15655657 DOI: 10.1007/s10151-004-0124-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Synchronous and metachronous colorectal carcinoma have an incidence of 2-10%. The purpose of the study was to evaluate the clinical characteristics, the accuracy of diagnostic examinations and the survival of these patients. METHODS From 1970 to 1999, 1160 patients with colorectal cancer were admitted to our Department. During follow-up examination 50 patients (4.3%) were found to present with multiple primary colon cancers. Fifty-two per cent were synchronous and 48% metachronous tumours. RESULTS The overall 5-year survival of the patients was 45.87%. Mortality was 10% for multiple primaries, while in patients with single cancer was 4.1%. The overall 5-year survival of the patients with multiple primaries tumours was 46.67%. CONCLUSIONS Patients with colorectal cancer must be fully studied endoscopically. There has been an improvement in survival in recent years due to better surgical techniques, the introduction of more sophisticated examination methods and the meticulous follow-up of patients at risk.
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Affiliation(s)
- V Papadopoulos
- 1st Propedeutic Surgical Clinic, Aristotle's University, AHEPA Hospital, Thessaloniki, Greece.
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Papadopoulos VN, Michalopoulos A, Netta S, Basdanis G, Paramythiotis D, Zatagias A, Berovalis P, Harlaftis N. Prognostic significance of mucinous component in colorectal carcinoma. Tech Coloproctol 2005; 8 Suppl 1:s123-5. [PMID: 15655594 DOI: 10.1007/s10151-004-0131-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many factors influence survival in colorectal cancer patients, one of them is the mucinous component of the tumour. Mucinous adenocarcinoma is characterized by the extracellular mucin of more than 50% of the tumour volume. METHODS From 1970 to 1999, 1160 patients were admitted to our clinic for colorectal cancer. They were divided into four groups according to mucinous character of the tumour, in two time periods of 15 years. RESULTS There was an increase in the incidence of mucinous tumours from 20.8 to 30.5% in the second period. These tumours were more advanced (Dukes' C) and especially right sided (34.5% vs. 17.9%). Five-year survival was increased during the second period but was of a lesser degree in the mucinous group (51.5% vs. 65.5%). CONCLUSIONS Colorectal mucinous carcinomas present at a more advanced stage, predominantly in men, with higher right colon location rate, and a worse overall 5-year survival rate than the non-mucinous colorectal cancers.
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Affiliation(s)
- V N Papadopoulos
- 1st Propedeutic Surgical Clinic, Aristotle's University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
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Michalopoulos A, Papadopoulos V, Zatagias A, Fahantidis E, Apostolidis S, Haralabopoulos E, Netta S, Sasopoulou I, Harlaftis N. Metastatic breast adenocarcinoma masquerading as colonic primary. Report of two cases. Tech Coloproctol 2005; 8 Suppl 1:s135-7. [PMID: 15655598 DOI: 10.1007/s10151-004-0135-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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] [Indexed: 11/28/2022]
Abstract
BACKGROUND Common sites of metastasis for the breast cancer are bones, lungs, the central nervous system and liver. The colon is the rarest site of metastasis for the breast carcinoma. PATIENTS AND RESULTS We report our recent experience of two female patients, 55 and 57 years old respectively, who presented breast metastasis at the proximal transverse colon. They were operated for breast carcinoma followed by chemotherapy and radiotherapy, four and ten years before the metastasis was diagnosed. The symptoms were anaemia and bowel obstruction. Diagnosis was made by double contrast barium enema and colonoscopy. Postoperatively, both patients received systemic chemotherapy. At the follow-up, two and three years after, there is no evidence of recurrence or metastasis. CONCLUSIONS Patients with history of breast cancer presenting with anaemia and/or bowel obstruction should be examined for possible metastasis to colon and should be treated surgically followed by systemic chemotherapy.
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Affiliation(s)
- A Michalopoulos
- 1st Propedeutic Surgical Clinic, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
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Georgopoulos D, Matamis D, Xirouchaki N, Routsi C, Michalopoulos A, Maggina A, Dimopoulos G, Zakynthinos E, Nakos G, Thomopoulos G, Mandragos K, Vasiliadou G, Peftoulidou M, Maniati A. Crit Care 2005; 9:P336. [DOI: 10.1186/cc3399] [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: 11/10/2022] Open
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Basdanis G, Papadopoulos VN, Michalopoulos A, Apostolidis S, Harlaftis N. Randomized clinical trial of stapled hemorrhoidectomy vs open with Ligasure for prolapsed piles. Surg Endosc 2004; 19:235-9. [PMID: 15573239 DOI: 10.1007/s00464-004-9098-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [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: 04/18/2004] [Accepted: 08/19/2004] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of the study was to compare the results in 95 patients randomly allocated to undergo either stapled or open hemorrhoidectomy using Ligasure. METHODS Ninety-five patients with grade III and IV hemorrhoids were randomly allocated to undergo either stapled (50 patients) or open using Ligasure (45 patients). Stapled hemorrhoidectomy was performed with the use of a circular stapling device. Open hemorrhoidectomy was accomplished according to the Milligan-Morgan technique by using Ligasure. Postoperative pain was assessed by means of a visual analog scale (VAS). Recovery evaluation included return to pain-free defecation and normal activities. A 6-month clinical follow-up and an 18 (12-24) month median telephone follow-up were obtained in all patients. RESULTS Operation time for open hemorrhoidectomy using Ligasure was shorter [median 13 (range 9.2-16.1) min vs 15 (range 8-17) minutes, p < 0.05]. Median range of VAS score in the stapled group were significantly lower [VAS score after 8 h: 3 (2-6) vs 5 (3-8), p < 0.01; VAS score after first defecation: 5 (3-8) vs 7 (3-9), p < 0.001. The stapled hemorrhoidectomy was associated with an increased incidence of intraoperative bleeding in 18 cases (36%) vs four cases (8.8%) of the Ligasure group. There were three cases (6%) from the stapled group with recurrence of the hemorrhoids and none from the open technique. CONCLUSIONS Hemorrhoidectomy with a circular stapler device is easy to perform, but one more line of clips must be added to the device to avoid intraoperative bleeding from the cut line. Hemorrhoidectomy performed using Ligasure is more painful postoperatively but is a more radical operation.
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Affiliation(s)
- G Basdanis
- 1st Propedeutic Surgical Clinic, Aristotle's University of Thessaloniki, A.H.E.P.A. Hospital, T. Ikouomidi 21, 551 31, Kalamaria, Thessaloniki, Greece
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Basdanis G, Michalopoulos A, Papadopoulos V, Tzeveleki I, Efthimiadis C, Kosmidis C, Mekras D, Harlaftis N. Clinical short-term results of radiofrequency ablation in patients with liver metastases from colorectal cancer. Tech Coloproctol 2004; 8 Suppl 1:s187-9. [PMID: 15655617 DOI: 10.1007/s10151-004-0152-7] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to examine the therapeutic efficacy of radiofrequency tumour ablation in patients with liver metastases from colorectal cancer who are not suitable for hepatic resection. PATIENTS AND METHODS Between April 2002 and January 2004, 18 patients underwent open radiofrequency ablation (RFA) for colorectal liver metastases. Median lesion size was 5.6 cm (range 3.0-8.0 cm). Patient's follow-up included ultrasound and computed tomography imaging at 3, 6 and 18 months postoperatively. RESULTS Mean total procedure time was 86 min. The average hospital stay was 5 days. There was no treatment-related mortality. Twelve patients (66.7%) experienced mild right hypochondrium discomfort for 3 days and 6 patients (33.4%) low-grade fever for 4 days. Four patients died within 12 months with extrahepatic disease. In 4 patients lesions increased in size or new lesions developed, 7 patients are alive, symptom-free, with stable disease and 4 patients are free of disease. CONCLUSIONS RFA is a safe, well tolerated procedure for the treatment of unresectable colorectal liver metastases.
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Affiliation(s)
- G Basdanis
- 1st Propedeutic Surgical Department, Aristotle University, AHEPA Hospital, Thessaloniki, Greece.
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Michalopoulos A, Papadopoulos VN, Basdanis G, Haralabopoulos E, Zatagias A, Netta S, Apostolidis S, Fahantidis E. Colorectal gastrointestinal mesenchymal tumours. Report of a stromal case of the rectum (GIST) and a leiomyosarcoma of the transverse colon. Tech Coloproctol 2004; 8 Suppl 1:s155-7. [PMID: 15655606 DOI: 10.1007/s10151-004-0142-9] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. They are positive to C-kit (CD 117), more common in the older males, and mostly in the stomach, less in the colon and rectum and oesophagus. Benign tumours are more common than the malignant ones. Classification of GISTs is based on morphology and immunochemistry. METHODS We report two cases of colorectal gastrointestinal mesenchymal tumours, one on the transverse colon which was found to be immunohistochemically leiomyosarcoma and the other on the rectum which met the GIST criteria. The patients underwent transversectomy and abdominal perineal resection, respectively. CONCLUSIONS They did not receive Imanitib postoperatively and two years after there is no evidence of recurrence. Surgery is the treatment of choice for resectable GISTs, and other mesenchymal tumours benign or malignant.
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Affiliation(s)
- A Michalopoulos
- 1st Propedeutic Surgical Clinic, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
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Basdanis G, Papadopoulos VN, Michalopoulos A, Fahantidis E, Apostolidis S, Berovalis P, Zatagias A, Karamanlis E. Colorectal cancer in patients over 70 years of age: determinants of outcome. Tech Coloproctol 2004; 8 Suppl 1:s112-5. [PMID: 15655591 DOI: 10.1007/s10151-004-0128-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to evaluate operative risk factors, the mortality, morbidity and survival in old patients with colorectal cancer. METHODS From 1160 patients with colorectal cancer, 398 patients aged 70 years or older, from 1970 to 2000, were followed-up. Dukes' classification, differentiation, sex, anatomical site and survival were compared with patients <70 years old. RESULTS Long-term results have been proved to be similar both in young and old patients. Relative survival rate for patients aged 70-95 (70.5%) were similar to those for patients less than 70 years old (71.6%) and also comparable between male (72.3%) and female (68%) patients. CONCLUSIONS Elderly patients have a lower capacity to react to postoperative complications, but the relative survival is similar to younger patients. Advanced age alone should not be used as a criterion to deny surgery for colorectal cancer.
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Affiliation(s)
- G Basdanis
- 1st Propedeutic Surgical Clinic, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
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Rizos M, Falagas ME, Tsiodras S, Betsou A, Foukas P, Michalopoulos A. Usual interstitial pneumonia associated with cytomegalovirus infection after percutaneous transluminal coronary angioplasty. Eur J Clin Microbiol Infect Dis 2004; 23:848-50. [PMID: 15480886 DOI: 10.1007/s10096-004-1220-7] [Citation(s) in RCA: 3] [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] [Indexed: 10/26/2022]
Abstract
An unusual case of cytomegalovirus (CMV) pneumonia in a diabetic patient is presented. The diagnosis was based on typical histopathological findings including intranuclear inclusion bodies combined with molecular identification of CMV in tissue specimens. The possibility of CMV reactivation associated with a previous cardiac procedure, which led to the development of usual interstitial pneumonia, is discussed. Clinicians should be aware of CMV-associated severe bilateral pneumonia developing after cardiac procedures even in non-transplant patients. The correct diagnosis depends on clinical awareness in the appropriate setting along with proof of viral infection.
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Affiliation(s)
- M Rizos
- Intensive Care Unit, Henry Dunant Hospital, 107 Mesogeion Avenue, 11526 Athens, Greece
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Gatzonis SD, Zournas C, Michalopoulos A, Prapas S, Argentos S, Geroulanos S. Area-selective stimulus-provoked seizures in post-anoxic coma. Seizure 2002; 11 Suppl A:294-7. [PMID: 12185763] [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: 02/26/2023] Open
Abstract
We describe the case of a 70-year-old patient in whom hemiconvulsive seizures occurred during metabolic derangement, multiple stroke and post-anoxic coma following cardiac arrest. We employed the methods of clinical and EEG evaluation and CT brain scan. We found that hemiconvulsive seizures were provoked following a light tactile stimulus in the left-trigeminal area and occasionally a strong tapping in the right-trigeminal area. We conclude that this type of stimulus-provoked seizure is extremely rare and could be explained by diffuse and severe brain damage.
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Affiliation(s)
- S D Gatzonis
- Department of Neurology, Athens Medical School, Eginition Hospital, Athens, Greece.
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Michalopoulos A, Geroulanos S, Papadimitriou L, Papadakis E, Triantafillou K, Papadopoulos K, Palatianos G. Mild or moderate chronic obstructive pulmonary disease risk in elective coronary artery bypass grafting surgery. World J Surg 2001; 25:1507-11. [PMID: 11775182 DOI: 10.1007/s00268-001-0161-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 11/29/2022]
Abstract
A history of chronic obstructive pulmonary disease (COPD) is considered a risk factor in patients undergoing coronary artery bypass grafting (CABG) surgery. The objective of this study was to examine the impact of history of mild or moderate COPD on outcome in patients undergoing elective CABG surgery. In this prospective, case-controlled study, we compared two groups of adult patients undergoing elective CABG surgery. In this prospective, case-controlled study, we compared two groups of adult patients undergoing elective CABG surgery. There were no statistically significant differences regarding early postoperative complications between the groups (p > 0.05). The median duration of mechanical ventilation and ICU length of stay were 0.4 and 1 days, respectively, in the two groups. The mean (+/- SD) hospital stay was 7.8 +/- 1.6 days in the COPD group and 7.5 +/- 1.3 days in the control group (p = 0.1). The mortality rate was found 1.4% in COPD patients and 0.7% in the control group (p = 0.5). We concluded that patients with a history of mild or moderate COPD undergoing elective CABG had morbidity and mortality rates comparable with those of controls (p > 0.05).
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Affiliation(s)
- A Michalopoulos
- Third Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece.
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Abstract
We describe the case of a 70-year-old patient in whom hemiconvulsive seizures occurred during metabolic derangement, multiple stroke and post-anoxic coma following cardiac arrest. We employed the methods of clinical and EEG evaluation and CT brain scan. We found that hemiconvulsive seizures were provoked following a light tactile stimulus in the left-trigeminal area and occasionally a strong tapping in the right-trigeminal area. We conclude that this type of stimulus-provoked seizure is extremely rare and could be explained by diffuse and severe brain damage.
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Affiliation(s)
- S D Gatzonis
- Department of Neurology, Athens Medical School, Eginition Hospital, Greece.
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Abstract
OBJECTIVE To examine the optimal duration of antibiotic prophylaxis in major cardiovascular surgery. MTHODSs: In the past 15 years, four prospective randomized, controlled studies, conducted by the same group of authors, compared seven prophylactic antimicrobial regimens in 2970 patients undergoing major cardiovascular surgery. In 1980/81, a 4-day cefazolin (CFZ) prophylaxis was compared with a 2-day cefuroxime (CFX) administration (n=566). In 1982/83, a 2-day CFX prophylaxis was compared with a two shot ceftriaxone (CRO) prophylaxis (n=512). In 1984/87, a 1-day CFZ prophylaxis was compared with a single shot prophylaxis of CRO (n=883). In 1994/1995, a 4 day combination of amoxicillin (AM) and netilmicin (NET) prophylaxis was compared with a single shot prophylaxis of CFX (n=1009). RESULTS Total infection rate varied between 4.5 and 5.7%, despite different antimicrobial regimen used and their varying duration. Wound infection rate was 1.1% (range 0.4-2.5%), sepsis rate was 0.8% (range 0.4-1.6%), pneumonia rate 2% (0.7-2.9%), urinary tract infection rate 0.4% (range 0-1.4%), and central venous catheter-related infection rate was 0.4% (0-1%). The 30-day mortality rate was 1.3% (range 0.4-2%). All these differences were not statistically significant. CONCLUSIONS A low infection rate (range 4.5-5.7%) occurred despite changes in duration of various prophylactic antibiotic regimen with cephalosporins of first, second or third generation. As a single shot prophylaxis could nowadays successfully be used in cardiovascular surgery, no postoperative antibiotics should be used, unless an intraoperative or a postoperative infection is documented or in presence of major perioperative complications.
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Affiliation(s)
- I Kriaras
- Department of Surgical Intensive Care, Onassis Cardiac Surgery Center, 356 Sygrou Avenue, 17674, Athens, Greece
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