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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Spartalis M, Spartalis E, Tzatzaki E, Tsilimigras DI, Moris D, Kontogiannis C, Iliopoulos DC, Voudris V, Siasos G. Cardiac allograft vasculopathy after heart transplantation: current prevention and treatment strategies. Eur Rev Med Pharmacol Sci 2020; 23:303-311. [PMID: 30657571 DOI: 10.26355/eurrev_201901_16777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Cardiac allograft vasculopathy (CAV) is a leading cause of mortality in heart transplantation patients. Despite optimal immunosuppression therapy, the rate of CAV post-transplantation remains high. In this review, we gathered all recent studies as well as experimental evidence focusing on the prevention and treatment strategies regarding CAV after heart transplantation. MATERIALS AND METHODS A complete literature survey was performed using the PubMed database search to gather available information regarding prevention and treatment strategies of CAV after heart transplantation. RESULTS Several non-immune and immune factors have been linked to CAV such as ischemic reperfusion injury, metabolic disorders, cytomegalovirus infection, coronary endothelial dysfunction, injury and inflammation respectively. Serial coronary angiography combined with intravascular ultrasound is currently the method of choice for detecting early disease. Biomarkers and noninvasive imaging can also assist in the early identification of CAV. Treatment strategies such as mammalian target of rapamycin inhibitors proceed to grow, but prevention remains the objective. CONCLUSIONS Early detection is the key to therapy management. It enables early identification and diagnosis of patients with CAV, who would gain the most from prompt treatment. Further investigation is needed to elucidate the multifactorial pathophysiological process of CAV, develop detection methods and find treatments that prevent or slow disease progression.
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Affiliation(s)
- M Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
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Tsilimigras DI, Moris D, Hyer JM, Bagante F, Sahara K, Moro A, Paredes AZ, Mehta R, Ratti F, Marques HP, Silva S, Soubrane O, Lam V, Poultsides GA, Popescu I, Alexandrescu S, Martel G, Workneh A, Guglielmi A, Hugh T, Aldrighetti L, Endo I, Sasaki K, Rodarte AI, Aucejo FN, Pawlik TM. Hepatocellular carcinoma tumour burden score to stratify prognosis after resection. Br J Surg 2020; 107:854-864. [PMID: 32057105 DOI: 10.1002/bjs.11464] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/23/2019] [Accepted: 11/15/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although the Barcelona Clinic Liver Cancer (BCLC) staging system has been largely adopted in clinical practice, recent studies have emphasized the need for further refinement and subclassification of this system. METHODS Patients who underwent hepatectomy with curative intent for BCLC-0, -A or -B hepatocellular carcinoma (HCC) between 2000 and 2017 were identified using a multi-institutional database. The tumour burden score (TBS) was calculated, and overall survival (OS) was examined in relation to TBS and BCLC stage. RESULTS Among 1053 patients, 63 (6·0 per cent) had BCLC-0, 826 (78·4 per cent) BCLC-A and 164 (15·6 per cent) had BCLC-B HCC. OS worsened incrementally with higher TBS (5-year OS 77·9, 61 and 39 per cent for low, medium and high TBS respectively; P < 0·001). No differences in OS were noted among patients with similar TBS, irrespective of BCLC stage (61·6 versus 58·9 per cent for BCLC-A/medium TBS versus BCLC-B/medium TBS, P = 0·930; 45 versus 13 per cent for BCLC-A/high TBS versus BCLC-B/high TBS, P = 0·175). Patients with BCLC-B HCC and a medium TBS had better OS than those with BCLC-A disease and a high TBS (58·9 versus 45 per cent; P = 0·005). On multivariable analysis, TBS remained associated with OS among patients with BCLC-A (medium TBS: hazard ratio (HR) 2·07, 95 per cent c.i. 1·42 to 3·02, P < 0·001; high TBS: HR 4·05, 2·40 to 6·82, P < 0·001) and BCLC-B (high TBS: HR 3·85, 2·03 to 7·30; P < 0·001) HCC. TBS could also stratify prognosis among patients in an external validation cohort (5-year OS 79, 51·2 and 28 per cent for low, medium and high TBS respectively; P = 0·010). CONCLUSION The prognosis of patients with HCC varied according to the BCLC stage but was largely dependent on the TBS.
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Affiliation(s)
- D I Tsilimigras
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - D Moris
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - J M Hyer
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - F Bagante
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA.,Department of Surgery, University of Verona, Verona, Italy
| | - K Sahara
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - A Moro
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - A Z Paredes
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - R Mehta
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
| | - F Ratti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - H P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - S Silva
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - O Soubrane
- Department of Hepatobiliopancreatic Surgery, Assistance Publique - Hôpitaux de Paris, Beaujon Hospital, Clichy, France
| | - V Lam
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - G A Poultsides
- Department of Digestive Disease Institute, Stanford University, Stanford, California, USA
| | - I Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - S Alexandrescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - G Martel
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - A Workneh
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - A Guglielmi
- Department of Surgery, University of Verona, Verona, Italy
| | - T Hugh
- Department of Surgery, University of Sydney, School of Medicine, Sydney, New South Wales, Australia
| | - L Aldrighetti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - I Endo
- Yokohama City University School of Medicine, Yokohama, Japan
| | - K Sasaki
- Department of Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - A I Rodarte
- Department of Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - F N Aucejo
- Department of Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - T M Pawlik
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, USA
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Kontos M, Riza E, Tsiampalis T, Kirkilesis G, Bokos I, Moris D, Darema M, Andriopoulos A, Varletzidou A, Vernadakis S, Nikolaidis C, Lionaki S, Sarantzi X, Anagnostopoulou C, Boletis I, Zavos G. Breast cancer incidence and survival in renal transplant patients: 35-year experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.055] [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: 11/14/2022] Open
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Tsilimigras DI, Moris D, Pawlik TM. Comment on: Major hepatectomy with or without pancreatoduodenectomy for advanced gallbladder cancer. Br J Surg 2019; 106:1100-1101. [PMID: 31260585 DOI: 10.1002/bjs.11238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 11/12/2022]
Affiliation(s)
- D I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - D Moris
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - T M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Schizas D, Katsaros I, Koliakos N, Ntomi V, Tsilimigras DI, Moris D, Misiakos EP, Zavras N, Bakopoulos A. An alternative management of a Littré hernia case: food for thought. G Chir 2019; 40:360-363. [PMID: 32011993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM We present a novel approach to a Littré hernia case. CASE REPORT A 62-year old male presented at our department with a painless mass in the inguinal area and was successfully treated for an inguinal Littré hernia. A Lichtenstein tension-free mesh repair was used without performing simultaneous diverticulectomy. DISCUSSION Resection of an asymptomatic Meckel's diverticulum remains a controversial issue. In adult population, leaving an accidentally found silent Meckel's diverticula in situ could reduce the risk of postoperative complications without increasing late complications. Mesh-based techniques provide lower recurrence rates compared to non-mesh techniques. CONCLUSIONS Management of asymptomatic Littré hernias presents a challenge for the operating surgeon. Treatment guidelines should be developed for the optimal management of these patients.
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Makris S, Venetsanou K, Spartalis E, Kontogiannis C, Georgiopoulos G, Spartalis M, Tsilimigras DI, Moris D, Kakisis I, Karaolanis G, Patelis N, Zymvragoudakis V, Papasilekas TI, Themistoklis KM, Lazaris A. Changes in serum leptin levels as well as sICAM-1 and sVCAM-1 soluble adhesion molecules during carotid endarterectomy. Eur Rev Med Pharmacol Sci 2019; 23:2257-2262. [PMID: 30915774 DOI: 10.26355/eurrev_201903_17274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Leptin is an adipokine, known to be associated with oxidative stress, inflammation, and atherogenesis. Leptin plays an essential role in atheromatosis-associated inflammatory cascade through stimulation of inflammatory mediators such as soluble intracellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1). However, little is known about this association in patients with atherosclerosis and severe internal carotid artery (ICA) stenosis undergoing carotid endarterectomy (CEA). Our objective was to evaluate the variations of serum leptin levels, as well as sICAM-1 and sVCAM-1 levels in these patients during the process of CEA and 24 hours postoperatively. PATIENTS AND METHODS The study group enrolled 50 patients undergoing CEA for ICA stenosis (> 70%). Serum leptin, sICAM-1 and sVCAM-1 plasma concentration measurements were performed at 4 distinct time points: before clamping of the ICA, 30 minutes after clamping of the ICA, 60 minutes after declamping of ICA and 24 hours postoperatively. RESULTS Leptin was significantly decreased during CEA, but an overshooting in its levels was observed at 24 hours after the operation. Both sICAM-1 and sVCAM-1 initially followed the pattern of leptin changes but after completing CEA and up to 24 hours postoperatively a steep increase in their levels was not established. sVCAM-1 and sICAM-1 correlated with indices of oxidative stress at peak inflammatory burden. CONCLUSIONS Leptin is a circulating marker of carotid atherosclerosis. Oxidative stress and expression of sVCAM-1 and sICAM-1 on vascular endothelial cells are key features in the pathophysiological process of atherosclerosis.
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Affiliation(s)
- S Makris
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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Schizas D, Katsaros I, Tsapralis D, Moris D, Michalinos A, Tsilimigras DI, Frountzas M, Machairas N, Troupis T. Littre's hernia: a systematic review of the literature. Hernia 2018; 23:125-130. [PMID: 30506463 DOI: 10.1007/s10029-018-1867-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/25/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE A hernia containing Meckel's diverticulum is called a Littre's Hernia. It's a rare entity and its diagnosis is often incidental during routine hernia repair surgery. The objective of this study is the evaluation of the current evidence on Littre's hernias regarding their clinical presentation and optimal treatment approach. METHODS PubMed and Cochrane bibliographical databases were searched from the beginning of time (last search: August 1st, 2018) for studies reporting on Littre's hernias in adult population. RESULTS Forty-five studies met our inclusion criteria and reported collectively on 53 patients (21 males and 32 females) presenting at health care units with a Littre's hernia. The most common sites of occurrence were femoral (39.6%) and inguinal (34%). The vast majority of cases (77.4%) concerned incarcerated hernias. All patients underwent surgical hernia repair accompanied by a diverticulectomy and 16.9% of them received mesh. Only 7.5% of patients experienced immediate postoperative complications. CONCLUSIONS A Littre hernia is a rare complication of Meckel's diverticulum. It requires surgical attention and all medical professionals should be encouraged to report such cases to expand our experience and optimize the therapeutic approach.
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Affiliation(s)
- D Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece
| | - I Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece.
| | - D Tsapralis
- Surgical Department, General Hospital of Ierapetra, Ierapetra, Greece
| | - D Moris
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A Michalinos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece
| | - D I Tsilimigras
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece
| | - M Frountzas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Ag. Thoma 17 str., Goudi, 15771, Athens, Greece
| | - N Machairas
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - T Troupis
- Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens, Athens, Greece
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Schizas D, Michalinos A, Vergadis C, Oikonomou D, Baili E, Sougioultzis S, Moris D, Liakakos T. Gastric tube volvulus following an Ivor-Lewis esophagectomy. Ann R Coll Surg Engl 2018; 101:e1-e4. [PMID: 30286640 DOI: 10.1308/rcsann.2018.0146] [Citation(s) in RCA: 3] [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] [Indexed: 11/22/2022] Open
Abstract
Gastric tube conduit is the method of choice for restoring continuity of the digestive track after a partial or total esophagectomy. Redundant gastric conduit (i.e. an elongated, floppy conduit) is a rare cause of dysphagia in patients with long survival. Gastric tube volvulus is exceedingly rare with only three cases described in the literature. We present the diagnostic and therapeutic course of a 57-year-old man who presented to our department with gastric tube volvulus 32 months after an Ivor-Lewis esophagectomy. Diagnosis was made with computed tomography and volvulus was reduced endoscopically. To the best of our knowledge, this is only the fourth case of gastric tube volvulus described in the English literature. This rare situation might be a consequence of a redundant gastric tube. Endoscopic volvulus decompression was successful in our case.
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Affiliation(s)
- D Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon University Hospital , Athens , Greece
| | - A Michalinos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon University Hospital , Athens , Greece
| | - C Vergadis
- Radiology Department, Laikon University Hospital , Athens , Greece
| | - D Oikonomou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon University Hospital , Athens , Greece
| | - E Baili
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon University Hospital , Athens , Greece
| | - S Sougioultzis
- Gastroenterology Division, Department of Pathophysiology, National and Kapodistrian University of Athens, Laikon University Hospital , Athens , Greece
| | - D Moris
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon University Hospital , Athens , Greece
| | - T Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon University Hospital , Athens , Greece
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Bakopoulos A, Tsilimigras DI, Syriga M, Koliakos N, Ntomi V, Moris D, Bistarakis D, Schizas D. Diverticulitis of the transverse colon manifesting as colocutaneous fistula. Ann R Coll Surg Engl 2018; 100:e1-e3. [PMID: 30112933 PMCID: PMC6204519 DOI: 10.1308/rcsann.2018.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 12/25/2022] Open
Abstract
The transverse colon is a particularly rare site for a diverticulum to develop, with only few reports of solitary diverticula described in the literature. Among the reported complications, colocutaneous fistulas appear relatively infrequently. We describe the case of an 80-year-old woman with a solitary diverticulum of the transverse colon presenting as acute diverticulitis with abscess formation in the epigastric region. A fistulous tract was found between the inflamed colon and the skin. A wedge resection of the inflamed colon together with the fistula and the solitary diverticulum was performed followed by primary suturing of the healthy colonic tissue. Despite the sufficient treatment and thorough clearance of the area, the patient died ten days later from ventilator associated pneumonia. Although rare, in patients presenting with a subcutaneous abscess in the abdominal region, there should be a high level of suspicion for active intraperitoneal inflammation derived from complicated diverticular disease given the continuously elevated prevalence of the condition in Western societies. The decision regarding proper management of this clinical state should be based on thorough clinical examination and imaging.
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Affiliation(s)
- A Bakopoulos
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - DI Tsilimigras
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M Syriga
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - N Koliakos
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - V Ntomi
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Moris
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC, USA
| | - D Bistarakis
- Department of Surgery, Hygeia Hospital, Athens, Greece
| | - D Schizas
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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11
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Affiliation(s)
- D I Tsilimigras
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D Moris
- Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, USA
| | - T Liakakos
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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12
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Spartalis M, Tzatzaki E, Spartalis E, Moris D, Doulamis I, Triantafyllis AS, Livanis E, Theodorakis G. Cryoablation for atrial fibrillation and antiarrhythmic drug pretreatment: a single referral center experience. Eur Rev Med Pharmacol Sci 2018; 22:2088-2092. [PMID: 29687867 DOI: 10.26355/eurrev_201804_14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pulmonary vein isolation (PVI) ablation has emerged as the gold standard of ablative strategies to treat medically refractory paroxysmal and persistent atrial fibrillation (AF). Regardless of the superiority of catheter ablation based on PVI over antiarrhythmic drug therapy, recurrence rates of AF remain higher than desired. PVI via cryoablation has rapidly become a mainstream treatment for AF, due to its effectiveness and fast learning curve. Our objective was to assess the safety and efficacy of cryoablation in a single referral center. PATIENTS AND METHODS This is a retrospective analysis of results after cryoablation treatment of AF over three years. 146 patients with AF underwent a cryoablation procedure in our clinical center and were followed-up for three years after the procedure. All patients received cryoablation of the pulmonary veins, although concomitant procedures were performed in 6 patients (re-ablation), including radiofrequency and cryoablation. RESULTS Cryoablation was clinically successful in 90.83% of the patients with paroxysmal AF and 60% of those with persistent AF. The clinical success of cryoablation was correlated with pretreatment with amiodarone and in the case of re-ablation. Concerning postoperative complications, major bleeding was correlated with female gender, treatment with rivaroxaban and amiodarone. CONCLUSIONS Among large trials, freedom from recurrent AF is about 65% with follow-up limited to 1 to 2 years. PVI via balloon cryoablation is a safe and efficient guideline-based treatment for AF, producing a durable event-free result in most patients out to 3 years with better outcomes than previously reported.
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Affiliation(s)
- M Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
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13
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Spartalis M, Tzatzaki E, Spartalis E, Moris D, Doulamis I, Triantafyllis AS, Livanis E, Theodorakis G. Cryoablation for atrial fibrillation and antiarrhythmic drug pretreatment: a single referral center experience. Eur Rev Med Pharmacol Sci 2018. [PMID: 29687867 DOI: 10.26355/eurrev-201804-14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Pulmonary vein isolation (PVI) ablation has emerged as the gold standard of ablative strategies to treat medically refractory paroxysmal and persistent atrial fibrillation (AF). Regardless of the superiority of catheter ablation based on PVI over antiarrhythmic drug therapy, recurrence rates of AF remain higher than desired. PVI via cryoablation has rapidly become a mainstream treatment for AF, due to its effectiveness and fast learning curve. Our objective was to assess the safety and efficacy of cryoablation in a single referral center. PATIENTS AND METHODS This is a retrospective analysis of results after cryoablation treatment of AF over three years. 146 patients with AF underwent a cryoablation procedure in our clinical center and were followed-up for three years after the procedure. All patients received cryoablation of the pulmonary veins, although concomitant procedures were performed in 6 patients (re-ablation), including radiofrequency and cryoablation. RESULTS Cryoablation was clinically successful in 90.83% of the patients with paroxysmal AF and 60% of those with persistent AF. The clinical success of cryoablation was correlated with pretreatment with amiodarone and in the case of re-ablation. Concerning postoperative complications, major bleeding was correlated with female gender, treatment with rivaroxaban and amiodarone. CONCLUSIONS Among large trials, freedom from recurrent AF is about 65% with follow-up limited to 1 to 2 years. PVI via balloon cryoablation is a safe and efficient guideline-based treatment for AF, producing a durable event-free result in most patients out to 3 years with better outcomes than previously reported.
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Affiliation(s)
- M Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
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14
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Spartalis M, Tzatzaki E, Spartalis E, Damaskos C, Athanasiou A, Moris D, Politou M. The role of prasugrel in the management of acute coronary syndromes: a systematic review. Eur Rev Med Pharmacol Sci 2017; 21:4733-4743. [PMID: 29131238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Dual antiplatelet therapy (DAPT) is the treatment of choice in the medical management of patients with acute coronary syndrome (ACS). The combination of aspirin and a P2Y12 inhibitor in patients who receive a coronary stent reduces the rate of stent thrombosis and the rates of major adverse cardiovascular events. However, patients with acute coronary syndrome remain at risk of recurrent cardiovascular events despite the advance of medical therapy. The limitations of clopidogrel with variable antiplatelet effects and delayed onset of action are well established and lead to the development of newer P2Y12 inhibitors. Prasugrel is a selective adenosine diphosphate (ADP) receptor antagonist indicated for use in patients with ACS. Prasugrel provides greater inhibition of platelet aggregation than clopidogrel and has a rapid onset of action. We have conducted a systematic review to retrieve current evidence regarding the role of prasugrel in the management of ACS. Evidence comparing prasugrel, clopidogrel, and ticagrelor remain scant. MATERIALS AND METHODS A complete literature survey was performed using PubMed database search to gather available information regarding management of acute coronary syndromes and prasugrel. An explorative comparison of the safety and efficacy of prasugrel, clopidogrel, and ticagrelor was also conducted. RESULTS Prasugrel and ticagrelor are more efficacious than clopidogrel in reducing the occurrence of non-fatal myocardial infarction, stroke, or cardiovascular (CV) death but they have also an increased risk of major bleeding in comparison to clopidogrel. CONCLUSIONS Prasugrel and ticagrelor are today the recommended first-line agents in patients with ACS. The estimation of which drug is superior over the other cannot be reliably established from the current trials.
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Affiliation(s)
- M Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
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15
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Spartalis E, Damaskos C, Moris D, Athanasiou A, Spartalis M, Karagkiouzis G, Schizas D, Dimitroulis D, Tomos P. Successful combined surgical approach in a rare case of retrotracheal goitre in a patient with anatomical impediments. Folia Morphol (Warsz) 2017; 77:166-169. [PMID: 28832090 DOI: 10.5603/fm.a2017.0072] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/27/2017] [Indexed: 12/07/2022]
Abstract
Diving goitres can descend the cervical region expanding directly into the thoracic cavity. In most cases, diving goitres extend into the anterosuperior compartment, but they may also extend behind the trachea. We herein present a case of a male patient with retrotracheal goitre and history of left thyroid lobectomy and median sternotomy for thoracic aortic aneurysm repair with graft placement. After detailed preoperative evaluation, the patient underwent surgical resection of the mass through a combined approach; the existing cervical incision and a right posterolateral mini-thoracotomy. The postoperative course of the patient was uncomplicated. One year after surgery, the patient is asymptomatic and disease-free. (Folia Morphol 2018; 77, 1: 166-169).
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Affiliation(s)
- E Spartalis
- 2nd Department of Propedeutic Surgery, University of Athens Medical School.
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16
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Spyrou I, Davakis S, Moris D, Lakiotaki E, Dimitrokallis N, Papalampros A, Schizas D, Pikoulis E, Felekouras E. Inflammatory pseudotumour of the colon. Ann R Coll Surg Engl 2017; 99:e151-e153. [PMID: 28462661 DOI: 10.1308/rcsann.2017.0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction A colorectal inflammatory myofibroblastic tumour (IMT) is a rare but benign entity masquerading as a malignant tumour. Although the lung is considered the most common site of occurrence, IMTs may arise in diverse extrapulmonary locations. We describe a case of a colonic IMT in a patient who presented in the emergency setting. Case History A 77-year-old man was admitted at our emergency department with acute abdominal pain. Physical examination revealed vague tenderness of the lower abdomen and non-palpable masses. Preoperative evaluation revealed a mass in the right lower quadrant of the abdomen, possibly originating from the terminal ileum, 1-2cm from the caecum. Owing to the clinical impression of a potentially malignant lesion, the patient underwent subtotal colectomy and omentectomy. The pathology report suggested the morphological and immunohistochemical features were more compatible with a colonic IMT. Conclusions A colorectal IMT is a rare clinical entity that can easily mimic a highly malignant tumour and cannot be distinguished clinically or radiologically. An accurate diagnosis is based on histological examination and surgical resection is therefore usually required.
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Affiliation(s)
- I Spyrou
- National and Kapodistrian University of Athens , Greece
| | - S Davakis
- National and Kapodistrian University of Athens , Greece
| | - D Moris
- National and Kapodistrian University of Athens , Greece
| | - E Lakiotaki
- National and Kapodistrian University of Athens , Greece
| | | | - A Papalampros
- National and Kapodistrian University of Athens , Greece
| | - D Schizas
- National and Kapodistrian University of Athens , Greece
| | - E Pikoulis
- National and Kapodistrian University of Athens , Greece
| | - E Felekouras
- National and Kapodistrian University of Athens , Greece
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17
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Douvas I, Moris D, Karaolanis G, Bakoyiannis C, Georgopoulos S. Evaluation of cerebrovascular reserve capacity in symptomatic and asymptomatic internal carotid stenosis with transcranial Doppler. Physiol Res 2016; 65:917-925. [PMID: 27539111 DOI: 10.33549/physiolres.933303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cerebrovascular reserve capacity (CVRC) is a hemodynamic parameter indicating the brain's capacity to overcome ischemia. Transcranial Doppler (TCD) is a useful device to measure CVRC, with high availability and low cost. The aim of the study is to investigate asymptomatic patients with affected CVRC, who could benefit from CEA. One hundred and forty five consecutive patients (60 symptomatic and 65 asymptomatic), with internal carotid artery (ICA) stenosis >70 % and 20 healthy individuals without internal carotid stenosis underwent TCD-inhalation CO(2) tests in order to measure the CVRC in both hemispheres of each patient. CVRC between asymptomatic and symptomatic patients were significantly different in the 95 % confidence interval (CI) as well as the mean CVRC value in contralateral carotid artery. The correlation between CVRC in the carotid artery with stenosis and the existence of symptoms is significant at the 0.01 level. Additionally, symptoms and CVRC of the contralateral carotid artery are also significant at the 0.05 level and CVRC values in asymptomatic patients and the control group at the 0.01 level. None of the covariant factors, except the age, are significantly correlated with CRVC. CVRC could be an early mark-index to evaluate the risk of stroke in this group of patients and to design their therapeutic approach.
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Affiliation(s)
- I Douvas
- First Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, School of Medicine, Athens, Greece.
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18
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Papalampros A, Niehaus K, Moris D, Fard-Aghaie M, Stavrou G, Margonis AG, Angelou A, Oldhafer K. A safe and feasible “clock-face” duct-to-mucosa pancreaticojejunostomy with a very low incidence of anastomotic failure: A single center experience of 248 patients. J Visc Surg 2016; 153:425-431. [DOI: 10.1016/j.jviscsurg.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Vailas MG, Vernadakis S, Moris D, Zavos G. Surgical Dead End in a Renal Transplant Recipient Associated With a Rare Thrombohemorrhagic Syndrome. Transplant Proc 2015; 47:2537-40. [PMID: 26518966 DOI: 10.1016/j.transproceed.2015.09.021] [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] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/02/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary breast angiosarcoma is an extremely rare malignancy. Association of this type of tumor with Kasabach-Merritt syndrome has only been reported in 3 cases in the past. To our knowledge, this is the first reported case of a solid-organ recipient. METHODS A 53-year-old woman who underwent a deceased-donor renal transplantation 5 years previously presented with a 12-month history of a giant ulcerated lesion on her left breast. Biopsy of the overlying skin suggested primary angiosarcoma. Concurrently, the patient's bleeding from the site of the biopsy and hematology investigations indicated the presence of Kasabach-Merritt syndrome. RESULTS The case was discussed in a multidisciplinary setting. The decision was to use anthracycline-based chemotherapy as up-front treatment to assess tumor response and gain a local benefit for a subsequent resection. After the completion of 1 cycle of chemotherapy, the patient died of cardiovascular insufficiency. Primary angiosarcoma of the breast occurs in the third to fourth decade and has been reported only in women. CONCLUSIONS A high clinical suspicion and referral to a specialized center are necessary. Total mastectomy appears to be the only treatment conferring benefit; chemotherapy and radiation therapy are of little value.
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Affiliation(s)
- M G Vailas
- Transplantation Unit, Athens University School of Medicine, Laiko General Hospital, Athens, Greece.
| | - S Vernadakis
- Transplantation Unit, Athens University School of Medicine, Laiko General Hospital, Athens, Greece
| | - D Moris
- Transplantation Unit, Athens University School of Medicine, Laiko General Hospital, Athens, Greece
| | - G Zavos
- Transplantation Unit, Athens University School of Medicine, Laiko General Hospital, Athens, Greece
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Bakoyiannis C, Karaolanis G, Moris D, Palla V, Skrapari I, Bastounis E, Georgopoulos S. Homocysteine as a risk factor of restenosis after carotid endarterectomy. INT ANGIOL 2015; 34:166-171. [PMID: 25394952] [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: 06/04/2023]
Abstract
AIM Homocysteine (Hcy) has been identified as a potential risk factor for vascular disease. This study investigates the role of serum Hcy as clinical risk factor for restenosis after carotid endarterectomy (CEA). METHODS In a prospective design, we studied patients who underwent carotid endarterectomy with venous patch closure technique with respect to alterations of Hcy levels pre and postoperatively. The patients studied were subjected to reevaluation for possible restenosis at time-points 3, 6, 9, 12, 18 and 24 months postoperatively. RESULTS Fifty-three symptomatic and 37 asymptomatic patients with stenosis of internal carotid artery >70% were studied. Restenosis appeared in 7.25% of the patients within 24 months postoperatively. Hcy was the only parameter that correlated significantly with the presence of restenosis (P=0.010) and the presence of type VI (complicated) atheromatous plaque (P=0.005) within 24 months postoperatively. CONCLUSION Hcy levels were found to be statistically significantly correlated with both the presence of complicated atheromatous plaque and the degree of internal carotid artery restenosis after CEA.
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Affiliation(s)
- C Bakoyiannis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece -
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21
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Vernadakis S, Moris D, Mamarelis G, Fouzas I, Mathe Z, Kaiser G, Paul A, Sotiropoulos G. Single-center experience of transplantation for polycystic liver disease. Transplant Proc 2014; 46:3209-11. [PMID: 25420861 DOI: 10.1016/j.transproceed.2014.09.158] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Polycystic liver disease (PLD) may lead to massive hepatomegaly, abdominal distension, pain, and various degrees of dyspnea. The surgical treatment of this entity remains controversial. METHODS We report our experience from a retrospective analysis of 23 patients suffering from PLD who were treated with liver transplantation (LT) in our institution. RESULTS Liver transplantation for PLD patients with extensive hepatic involvement offers excellent symptoms relief. The actuarial 1-, 3-, and 5-year survival rate after transplantation was 86%. CONCLUSIONS Our experience demonstrates that PLD patients with extensive hepatic involvement and who are treated with LT have good long-term prognosis and excellent symptoms relief. LT might be considered in severe PLD cases where conventional surgery is not a curative option, and it must be balanced against the risks of LT and lifelong commitment to immunosuppression.
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Affiliation(s)
- S Vernadakis
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Germany
| | - D Moris
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Germany
| | - G Mamarelis
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Germany.
| | - I Fouzas
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Germany
| | - Z Mathe
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Germany
| | - G Kaiser
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Germany
| | - A Paul
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Germany
| | - G Sotiropoulos
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Germany
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22
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Zavos G, Moris D, Vernadakis S, Bokos J, Lionaki S, Mamarelis G, Panagiotellis K, Zavvos V, Boletis I. Incidence and Management of Kaposi Sarcoma in Renal Transplant Recipients: The Greek Experience. Transplant Proc 2014; 46:3199-202. [DOI: 10.1016/j.transproceed.2014.09.165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vernadakis S, Moris D, Delimpalta C, Bokos J, Zavos G. Ovarian carcinosarcoma in a renal transplant recipient. A unique case of a rare tumor. Hippokratia 2014; 18:364-365. [PMID: 26052208 PMCID: PMC4453815] [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
INTRODUCTION De novo malignancies have become one of the leading causes of late mortality after renal transplantation, with their incidence being 2-15 fold higher than in general population. We present herein a unique case of ovarian carcinosarcoma in a renal transplant recipient. CASE REPORT A 69-year-old female renal transplant recipient presented with progressive distension and vague abdominal pain. Clinical examination revealed a large abdominal mass. Magnetic resonance imaging scan verified the presence of the mass. An exploratory laparotomy was performed, identifying a giant tumor measuring 33 x 22 x 10 cm. Optimal debulking surgery was performed, the postoperative course was uneventful and she was discharged on the 8(th) postoperative day. The final diagnosis was ovarian carcinosarcoma. The patient received adjuvant chemotherapy and at 6-month follow-up, she was disease-free. CONCLUSION Ovarian Carcinosarcoma is a rare and aggressive neoplasia, comprising 1-2 % of all ovarian tumors. Radical surgical approach, as well as appropriate chemotherapy are the cornerstone of treatment. In the presented case, where immunosuppression is involved, further evaluation should be made as far as immunosuppression dose reduction or switch is concerned.
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Affiliation(s)
- S Vernadakis
- Transplantation Unit, "Laikon" General Hospital, School of Medicine, University of Athens, Athens, Greece
| | - D Moris
- Transplantation Unit, "Laikon" General Hospital, School of Medicine, University of Athens, Athens, Greece
| | - C Delimpalta
- Transplantation Unit, "Laikon" General Hospital, School of Medicine, University of Athens, Athens, Greece
| | - J Bokos
- Transplantation Unit, "Laikon" General Hospital, School of Medicine, University of Athens, Athens, Greece
| | - G Zavos
- Transplantation Unit, "Laikon" General Hospital, School of Medicine, University of Athens, Athens, Greece
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Michalinos A, Moris D, Vernadakis S. Amyand's hernia: a case series with critics of role of appendectomy. Hernia 2014; 19:987-90. [PMID: 24384719 DOI: 10.1007/s10029-013-1209-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/21/2013] [Indexed: 12/01/2022]
Abstract
Amyand's hernia is an inguinal hernia that contains vermiform appendix in its sac. It consists 1% of all inguinal hernias while appendicitis in an Amyand's hernia accounts for 0.1% of all appendicitis cases. Its clinical image is identical to that of an incarcerated or perforated inguinal hernia. Diagnosis is usually established intraoperatively. Hernioplasty (with or without mesh repair and with or without appendectomy) is the treatment of choice. According to Losannof and Basson's criteria, performance of appendectomy shall depend on vermiform appendix's inflammation status. In this case series, authors present three patients who had to undergo prophylactic appendectomy because of medical conditions, unrelated to appendix's inflammation status thus escaping from therapeutic frame set by Losanoff and Basson's criteria.
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Affiliation(s)
- A Michalinos
- 1st Department of Surgery, Athens University School of Medicine, "Laikon" University Hospital, 2nd Floor, Agiou Thoma 17 Str., Goudi, 15771, Athens, Greece. .,Department of General and Transplantation Surgery, "Laikon" General University, Athens, Greece.
| | - D Moris
- 1st Department of Surgery, Athens University School of Medicine, "Laikon" University Hospital, 2nd Floor, Agiou Thoma 17 Str., Goudi, 15771, Athens, Greece.,Department of General and Transplantation Surgery, "Laikon" General University, Athens, Greece
| | - S Vernadakis
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.,Department of General and Transplantation Surgery, "Laikon" General University, Athens, Greece
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Willison HJ, Lastovica AJ, Prendergast MM, Moran AP, Walsh C, Flitcroft I, Eustace P, McMahon C, Smith J, Smith OP, Lakshmandass G, Taylor MRH, Holland CV, Cox D, Good B, Kearns GM, Gaffney P, Shark K, Frauenshuh M, Ortmann W, Messner R, King R, Rich S, Behrens T, Mahmud N, Molloy A, McPartlin J, Scott JM, Weir DG, Walsh KM, Thorburn D, Mills P, Morris AJ, Good T, Cameron S, McCruden EAB, Bennett MW, O’Connell J, Brady C, Roche D, Collins JK, Shanahan F, O’Sullivant GC, Henry M, Koston S, McMahon K, MacNee W, FitzGerald MX, O’Connor CM, McGonagle D, Gibbon W, O’Connor P, Emery P, Murphy M, Watson R, Casey E, Naidu E, Murphy M, Watson R, Barnes L, McCann S, Murphy M, Watson R, Barnes L, Sweeney E, Barrett EJ, Graham H, Cunningham RT, Johnston CF, Curry WJ, Buchanan KD, Courtney CH, McAllister AS, McCance DR, Hadden DR, Bell PM, Leslie H, Sheridan B, Atkinson AB, Kilbane MT, Smith DF, Murray MJ, Shering SG, McDermott EWM, O’Higgins NJ, Smyth PPA, McEneny J, Trimble ER, Young IS, Sharpe P, Mercer C, McMaster D, Young IS, Evans AE, Young IS, Cundick J, Hasselwander O, McMaster D, McGeough J, Savage D, Maxwell AP, Evans AE, Kee F, Larkin CJ, Watson RGP, Johnston C, Ardill JES, Buchanan KD, McNamara DA, Walsh TN, Bouchier-Hayes DJ, Madden C, Timon C, Gardiner N, Lawler M, O’Riordan J, Duggan C, McCann SR, Gowing H, Braakman E, Lawler M, Byrne C, Martens ACM, Hagenbeek A, McCann SR, Kinsella N, Cusack S, Lawler M, Baker H, White B, Smith OP, Lawler M, Gardiner N, Molloy K, Gowing H, Wogan A, McCann SR, McElwaine S, Lawler M, Hollywood D, McCann SR, Mcmahon C, Merry C, Ryan M, Smith O, Mulcahy FM, Murphy C, Briones J, Gardiner N, McCann SR, Lawler M, White B, Lawler M, Cusack S, Kinsella N, Smith OP, Lavin P, McCaffrey M, Gillen P, White B, Smith OP, Thompson L, Lalloz M, Layton M, Barnes L, Corish C, Kennedy NP, Flood P, Mulligan S, McNamara E, Kennedy NP, Flood P, Mathias PM, Ball E, Duiculescu D, Calistru P, O’Gorman N, Kennedy NP, Abuzakouk M, Feighery C, Brannigan M, 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Dalla-Vala F, Buret JP, Damas ML, Valetta H, Moris D. Parametres du métabolisme phospho-calcique au cours de la néphrose de l'enfant. Arch Pediatr 1996. [DOI: 10.1016/0929-693x(96)86219-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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