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Biomedical subjects

A Papachristodoulou

Publications and source records attributed to A Papachristodoulou.

16 recordsLinked to original sources
PubMed2006

Fournier's gangrene: exists and it is still lethal.

BACKGROUND: Fournier's gangrene is an aggressive form of necrotizing fascitis of the perineal, perianal or genital regions, caused by a polymicrobial infection that includes virulent organisms. PATIENTS AND METHODS: Eleven cases of Fournier's gangrene were treated in our department during the last 20 years. Portals of entry were ischiorectal abscess, perirectal abscesses, scrotal abscess and trauma in the perianal area. The documents were analyzed according to clinical and epidemiologic patterns. RESULTS: We dispensed systemic chemotherapy with broad-spectrum antibiotics, and performed surgical debridement for all patients. In addition, one patient was treated by local use of 100% oxygen, with excellent results in wound healing. All patients made a full recovery, except one who died of sepsis. CONCLUSION: These cases are presented with some notes underlying the reasons for the persisting incidence and mortality of this disease.

Adolescent↗
PubMed2006

Surgical management of nipple discharge.

PURPOSE: Nipple discharge is reported in 2.5-3% of women with breast carcinoma. Breast carcinoma is found in approximately 8% of surgically treated patients presenting with bloody nipple discharge (ND). METHODS: In the present study 110 women with ND as a presenting symptom were examined. The discharge was spontaneous in 76 and elicited in 11 patients. RESULTS: After surgical intervention benign breast disease was found in 85% of patients. Thirteen women (15%) were found to have malignancy and underwent additional surgery. Cytology of the discharge was positive or suspicious for malignancy in only seven out of 13 patients found to have in situ or invasive carcinoma. CONCLUSION: Women with spontaneous, single duct ND, especially when it is darkish or bloody, should have cytological examination of the fluid and mammography according to their age or additional clinical findings. Most of them will require a microdochectomy, as the possibility of finding a carcinoma among those women is between 10-15%. However, single duct papilloma is the most common cause of bloody discharge.

Adolescent↗
PubMed2004

Unusual presentation of renal cell carcinoma metastasis.

The aim of this study is to present an unusual site of renal cell carcinoma metastasis. A 60-year old man presented to our clinic with massive rectal bleeding. A large small intestine metastasis from renal cell carcinoma was evidenced by an elective angiography of the superior mesenteric artery. This metastasis was surgically excised.

Angiography↗
PubMed1999

Changing patterns in advanced gastric carcinoma.

A retrospective study on patients with gastric cancer during the periods 1984-88 (n = 63 patients) and 1989-93 (n = 59 patients) was made. The aim of the study was to assess any changing patterns in tumour distribution, surgical management and survival during the two periods. When the diagnosis was made, the majority of tumours were advanced: 58 were stage IV and 21 were stage IIIB, with 43 tumours at earlier stages. The incidence of proximally located gastric adenocarcinomas increased from 15.9 to 27.1%, while the incidence of carcinomas located in the body decreased from 34.9 to 23.7%. The majority of patients underwent conservative gastrectomy. The proportion of proximal gastrectomies increased from 3.2 to 15.3 per cent (p = 0.02), whereas the proportion of combined resection of adjacent organs decreased from 38.1 to 22.0 per cent (p = 0.04). Perioperative mortality rate decreased from 17.5 to 1.7 per cent (p = 0.003). Prognosis remained unchanged in the two periods; overall 5-year survival is calculated as 12 per cent.

Adenocarcinoma↗
PubMed1997

Surgical treatment of gastrointestinal B-cell mucosa-associated lymphoid tissue lymphomas.

We retrospectively evaluated clinicopathologic features of 35 patients treated for primary gastrointestinal lymphomas of MALT type (mucosa-associated lymphoid tissue) between 1970 and 1993. Fourteen patients (40%) were treated for acute abdominal conditions (bowel obstruction in 8, perforation in 2, and gastrointestinal bleeding in 4), and the rest had exploratory laparotomy. The tumor was located in the stomach in 23 patients (66%), in the jejunum and ileum in 10 (29%), and in the large intestine in 2 (6%). The type of operation was defined according to site and extent of disease. Most patients received chemotherapy postoperatively. Staging was done according to the Ann Arbor classification. Survival depended on stage and extension of the disease; 5-year survival was 45%. Surgical resection followed by adjuvant chemotherapy is warranted when the patient is considered to be a surgical candidate.

Adolescent↗
PubMed1997

[Experiences with surgical therapy of hepatic echinococcosis].

Between January 1984 and December 1990, 56 patients with hydatid liver disease were treated surgically at our Department. Diagnosis was made by using clinical criteria, serology and imaging techniques. Most frequent clinical symptom was abdominal pain or local discomfort (38 patients, 68%). Plain X-ray of the abdomen was helpful in 20 patients (36%), liver ultrasound in 53 (93%) and computerised tumorgraphy in 56 patients, (100%). The immunoelectrophoresis test of "arc 5" was sensitive in 51 patients (91%). Thirty patients (53%) underwent partial resection and omentoplasty, 17 patients (30%) underwent external drainage, two cystic resection (3%), one left lateral lobectomy (2%) and six (11%) underwent omentoplasty and T-tube insertion. Fatal complications did not occur. Four patients developed hepatic abscess (7%), three wound infection (5%), one bowel obstruction (2%) and in five instances (8%) drainage was maintained for more than three months. Of the 49 patients available for follow-up (87%), three (6%) developed recurrent disease.

Adult↗
PubMed1996

Biochemical modulation of fluorouracil: comparison of methotrexate, folinic acid, and fluorouracil versus folinic acid and fluorouracil in advanced colorectal cancer: a randomized trial.

Recent advances in biochemical pharmacology have revealed the basis for the biological modulation of 5-fluorouracil (5-FU) by methotrexate (MTX) and folinic acid (FA). Sequential use of MTX given 24 h prior to 5-FU has resulted in enhanced cell kill in vitro and in vivo. In addition, administration of FA prior to 5-FU has led to potentiation of 5-FU action by stabilization of the ternary complex of thymidine synthase. In the present randomized study, two groups of patients with advanced colorectal cancer were treated as follows: 43 patients (pts) in group A received 5-FU + FA, whereas 45 pts in group B received 5-FU + FA + MTX. The dosage was as follows: group A received FA i.v. at 300 mg/m2 per day, prior to i.v. 5-FU at 500 mg/m2 per day on days 1-4; group B was given MTX i.v. at 130 mg/m2 per day on day 0, followed 24 h later by FA at 15 mg q6h x 6, and 5-FU + FA was started on day 1 and given at the same doses and schedule described for group A. Objective responses were achieved by 8/43 pts in group A (1 complete response and 7 partial responses) and by 18/45 pts in group B (3 complete and 15 partial responses), all occurring in the liver. There was no significant difference in the median time to progression (group A 6.1 months, group B 6.8 months) or the median survival (group A 9.2 months, group B 10.3 months). Toxicity was significantly greater in group B [grade 2-3 mucositis 20% versus only 2% in group A (P < 0.0001); grade 3 diarrhea in group B 15% versus 3% in group A (P < 0.001)]. According to our results, double biological modulation of 5-FU with MTX + FA led to an enhanced response rate with increased toxicity as compared with the 5-FU + FA regimen given at less than its maximally tolerated dose.

Adenocarcinoma↗
PubMed1993

Obstructive colonic cancer.

The records of 121 patients with obstructing cancer of the colon were reviewed. About one-third of the patients had metastatic disease at the time of operation. Primary resection and anastomosis of the intestine was performed for most cancers of the ascending or transverse colon. Hartmann's procedure was performed in most patients with cancer of the sigmoid colon and rectum. Wound infection occurred in 20 patients (16.5%) and anastomotic leakage in six (4.9%). The operative mortality rate was 14.9%. The 5-year survival rate was 13.5%. Acute colonic obstruction is associated with high morbidity and mortality. The high incidence of advanced disease, advanced age, delay in tumour excision and unprepared bowel are some of the factors resulting in the poor prognosis of these patients.

Acute Disease↗
PubMed1992

Carcinoma arising in a duplicated colon.

One case of adenocarcinoma arising in a duplicated transverse colon is presented. Its unusual feature was the site of the carcinoma origin, which was the true colonic segment and not the duplication.

Abdominal Pain↗
PubMedDate not supplied

Recurrent liposarcomas of the abdomen and retroperitoneum: three case reports.

We report three cases of patients with liposarcomas of the abdomen who had been treated during the last 13 years (1980-1993). Two patients were men, aged 29 and 51 years, with tumors of the retroperitoneal space and the third patient was a woman aged 64 years with a tumor in the peritoneal cavity. Therapeutic treatment was as aggressive as possible excision of the tumor. In the case of the first male patient, the histological examination revealed a retroperitoneal myxoid liposarcoma which recurred 5 times within 13 years. In the second male patient, it revealed a well differentiated retroperitoneal liposarcoma of the sclerosing type which recurred 5 times within 5 years since the first treatment. Finally, the one female patient had 2 recurrences of myxoid liposarcoma of the abdomen 9 years after the first operation, presented with an infected mass and has been well since then.

Adult↗
PubMedDate not supplied

Surgical treatment of human echinococcosis.

Hydatid disease may affect several organs in the human body and thus represents a major challenge for the general surgeon. The aim of this study was to analyze the multiple clinical presentations of hydatid disease and the surgical options according to the involved organ. The medical records of 272 adult patients operated on for hydatid disease in our department during the period 1970-1996 were retrospectively reviewed. The most commonly involved organ was the liver (204 patients; 75%), followed by the lung (42 patients; 15.4%) and the spleen (14 patients; 5.1%). In 12 patients, the cysts were located in uncommon sites: in the pancreas (4 patients; 1.5%), the gallbladder (2 patients; 0.74%), the kidney, the thyroid gland, the breast, the pericardium, the supraclavicular region and the thigh (1 patient in each case; 0.37%). Clinical symptomatology varied according to anatomic location and pre-operative diagnosis was accomplished with plain abdominal films, ultrasound, computerized tomography and serological tests. The surgical procedures performed included simple closure with drainage, unroofing of the cyst with omentoplasty (for liver cysts), marsupialization, cyst excision, excision of the involved organ or combinations of procedures. Postoperative morbidity was mainly due to septic complications (n = 41), postoperative bleeding (n = 2), deep vein thrombosis (n = 2) and fistulae (n = 13). Four patients died in the early postoperative period (mortality rate, 1.5%) secondary to septic complications (n = 3) and pulmonary embolism (n = 1). During long-term follow-up, 14 patients developed recurrent disease. In conclusion, hydatid disease should be included in the differential diagnosis of cystic masses in solid organs or other anatomic sites, especially in endemic countries. Since there is not an effective medical treatment, surgery still remains the treatment of choice, offering a good clinical result and an acceptable recurrence rate.

Adult↗
PubMedDate not supplied

Local recurrence after radical surgery for colorectal cancer.

Local recurrence of colorectal cancer after curative surgery is a major clinical problem. The aim of our study was to present our experience in this field. Between January 1990 and December 2000, 572 patients underwent resection for colorectal cancer in our department; 66 of them had local recurrence within the first 2 years. Most of those patients had Dukes' stage B (n = 24) or stage C (n = 37) tumors, which were located mainly in the rectum (n = 40) and sigmoid colon (n = 18). The incidence of local recurrence was 11% and 15.9% for tumors that were Dukes' stages B and C, respectively. Thirty-five of 66 patients received palliative treatment, and 28 of them died within 9 months. The remaining 31 patients underwent radical excision of the recurrent tumor: 11 of these patients died within 2 years, and 20 were still alive after 30 months. The only hope for long-term survival for patients presenting with local recurrence from colorectal cancer after primary radical treatment is to identify local recurrence at an early stage and treat it in a radical manner.

Adult↗
PubMedDate not supplied

Gastrointestinal carcinoid tumors: 10-year experience of a general surgical department.

Gastrointestinal (GI) carcinoids are rare neuroendocrine tumors of great interest because of the multitude of the peptide hormones they produce, their clinical manifestations, the carcinoid syndrome they cause, their biologic behavior, and the methods of their surgical and adjuvant treatment. In this retrospective study, 25 patients with carcinoid tumors admitted and surgically treated in our department during the last 10 years are presented. Most of the cases were located in the ileum (n = 8) and appendix (n = 12). The remaining cases were located in the rectum (n = 2), stomach (n = 1), duodenum (n = 1), and ileocecal valve (n = 1). After tumor resection and postoperative treatment, mainly with somatostatin analogs, our patients had a good recovery, and only five deaths were reported during follow-up. Carcinoids, despite the fact that they are usually silent and diagnosed with advanced stage, have good prognosis and offer, after effective treatment, long survival.

Adolescent↗