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B Papaziogas

Publications and source records attributed to B Papaziogas.

At least 19 recordsLinked to original sources
PubMed2006

Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness.

BACKGROUND: Stent clogging is the major limitation of palliative treatment for malignant biliary obstruction. Metal stents have much better patency than plastic stents, but are more expensive. Preliminary data suggest that the recently designed plastic (Tannenbaum) stent has better duration of patency than the polyethylene stent. This study aimed to compare the efficacy and cost effectiveness between the Tannenbaum stent without side holes and the uncovered metal stent for patients with malignant distal common bile duct obstruction. METHODS: In this study, 47 patients (median age, 73 years, range, 56-86 years) with inoperable malignant distal common bile duct strictures were prospectively randomized to receive either a Tannenbaum stent (n = 24) or an uncovered self-expandable metal stent (n = 23). The patients were clinically evaluated, and biochemical tests were analyzed if necessary until their death or surgery for gastric outlet obstruction. Cumulative first stent patency and patient survival were compared between the two groups. Cost-effectiveness analysis also was performed for the two study groups. RESULTS: The two groups were comparable in terms of age, gender, and diagnosis. The median first stent patency was longer in the metal group than in the Tannenbaum stent group (255 vs 123.5 days; p = 0.002). There was no significant difference in survival between the two groups. The total cost associated with the Tannenbaum stents was lower than for the metal stents (17,700 vs 30,100 euros; p = 0.001), especially for patients with liver metastases (3,000 vs 6,900 euros; p < 0.001). CONCLUSIONS: Metal stent placement is an effective treatment for inoperable malignant distal common bile duct obstruction, but Tannenbaum stent placement is a cost-saving strategy, as compared with metal stent placement, especially for patients with liver metastases and expected short survival time.

Aged↗
PubMed2006

Endoloop-assisted polypectomy for large pedunculated colorectal polyps.

BACKGROUND: The use of an endoloop may minimize the risk for bleeding after endoscopic polypectomy of large colorectal polyps. This study aimed to assess the safety and efficacy of colonoscopic ligation of the stalk of large pedunculated polyps by means of an endoloop technique, and to focus particular attention on the instances in which the use of this device was unsuccessful. METHODS: This study retrospectively evaluated attempted endoloop endoscopic polypectomy in 33 patients (19 men and 14 women; mean age, 62.5 years) with large pedunculated polyps. RESULTS: Application of the endoloop was impossible in four patients, and the snare became entangled with the loop in one patient. The remaining 28 patients underwent endoloop-assisted polypectomy. Bleeding occurred in four patients, either because the loop slipped of the stalk after polypectomy (2 patients) or because a thin stalk (< or = 4 mm) was transected by the loop before polypectomy (2 patients). CONCLUSION: Colonoscopic polypectomy with an endoloop may be safer than conventional polypectomy. The reasons for technical failure of this technique include a narrow left colon lumen, a thin stalk (< or = 4 mm), and close cutting in relation to the site of encirclement by the loop.

Adult↗
PubMed2006

Safety and long-term follow-up of endoscopic snare excision of ampullary adenomas.

BACKGROUND: Adenomas of the duodenal papilla are rare. Because of their malignant potential, resection is mandatory. Options for resection include endoscopic resection techniques, transduodenal local excision, and pancreaticoduodenectomy. The aim of this retrospective study was to evaluate the safety and outcome of endoscopic snare resection of papillary adenomas in a Greek cohort of patients. METHODS: Fourteen patients (six women and eight men; age range, 42-76 years) were referred for endoscopic management of ampullary adenomas. A questionnaire was completed for each patient, which included preoperative and postoperative data points. Presenting symptoms were jaundice (n = 4), cholangitis (n = 1), and pain (n = 2). Seven patients were asymptomatic. If there was no common bile and main pancreatic duct invasion and the appearance suggested a benign lesion, biductal sphincterotomy onto normal duodenal tissue was performed. The adenomas were resected via a diathermy snare, along with the major papilla, after elevation of the lesion by epinephrine plus dextrose 50% (1:10,000) solution. At the discretion of the endoscopist, a biliary or pancreatic stent was inserted as a prophylactic procedure immediately after excision. RESULTS: Histopathologically, resected tissue included 11 adenomas and three adenomas with focal malignancy, referred for pancreaticoduodenectomy. Immediate complications were moderate bleeding (n = 1) and mild pancreatitis (n = 1). No procedure-related death occurred. Follow-up was available for 11 patients (mean, 28.36 months; range, 6-72). Pancreatic and biliary stents were placed in four and nine patients, respectively. Follow-up endoscopy revealed recurrent/residual adenomatous tissue in two patients (18%), which was resected endoscopically. CONCLUSION: Endoscopic snare resection of adenomas of the major duodenal papilla is a safe, well-tolerated alternative to surgical therapy. In expert hands, complications are mild and may be avoided by pre-resection biductal sphincterotomy, stent placement, and elevation of the lesion by epinephrine plus dextrose 50% solution injection.

Adenoma↗
PubMed2006

Gastric predominant hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is an autosomal-dominant disorder that frequently presents with epistaxis and gastrointestinal bleeding which may be a diagnostic and therapeutic challenge. We describe a 48-year-old monk with familiar history of HHT, who presented with frequent epistaxes and symptoms of ferropenic anemia. Upper gastrointestinal endoscopy revealed innumerable telangiectasias in the stomach. The patient underwent three sessions with argon plasma coagulation treatment but the results were poor. We also review the literature on the pathophysiology of the disease and discuss the suggested treatment.

Diagnosis, Differential↗
PubMed2006

A study on the morphology of the popliteus muscle and arcuate popliteal ligament.

The aim of this study was to investigate the origins and morphological features of the popliteus muscle in cadavers. In a sample of 40 lower limbs taken from cadavers the exact morphological features of the popliteus muscle were examined. In 100% of the cases studied we noticed, apart from the known femoral origin from the lateral femoral epicondyle, a fibular origin from the styloid process of the head of the fibula directed obliquely and blending with the main femoral origin, forming the arms of a Y-shaped structure. In all the cases a capsular origin was presented, while in 91.67% an origin lateral to it from the superior border of the posterior horn of the lateral meniscus was found. The capsular and meniscal origins formed the base of the Y-shaped structure that corresponded to the known arcuate ligament. We consider that the additional origins of the popliteus muscle form the arcuate ligament, which is not a distinct anatomical structure as it is described in traditional anatomical textbooks. In addition, we have analysed the exact morphological features of the capsular, fibular and meniscal origins of the popliteal muscle.

Cadaver↗
PubMed2005

Tension-free repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: a comparative study.

BACKGROUND: To compare tension-free hernia repair to a modified Bassini technique (Andrew's technique) used to treat complicated inguinal hernia. METHODS: In the period 1990-2004, 75 patients were submitted to emergency operation because of strangulated inguinal hernia. 33 patients underwent tension-free repair utilizing a polypropylene mesh (group A), whereas the remaining 42 patients underwent a modified Bassini technique (group B). RESULTS: Mean operative time was significantly longer for group B (91.5+/-9.3 min vs 75.7+/-10.5 min, p<0.05). Postoperative hospital stay was also significantly longer in group B compared to group A (10.3+/-3.4 days vs 4.5+/-2.1 days, p<0.01). Postoperative complication rate did not differ significantly between the two groups (5/33, 15.1% vs 5/42, 11.9%, p=n.s.). No mesh had to be removed. At follow-up (mean 9+/-4.2 years), there was one recurrence in group A (1/33, 3%) and two recurrences in group B (2/42, 4.7%) (p=n.s.). CONCLUSION: The presence of a strangulated inguinal hernia cannot be considered a contraindication for the use of a prosthetic mesh.

Aged↗
PubMed2005

Takayasu's arteritis and ulcerative colitis in a young non-Asian woman: a rare association.

The association between ulcerative colitis and Takayasu's arteritis has been well described in patients of Asian ethnicity. We present the third non-Asian case reported in the English literature, of a 37-year-old woman with a 4-year history of Takayasu's arteritis, who developed idiopathic ulcerative colitis. She was found to carry the human leucocyte antigens HLA-B52 and DR2, which have been previously noted to be associated with these inflammatory conditions, mainly in the Japanese population. Ulcerative colitis was steroid-dependent despite simultaneous administration of mesalazine. Azathioprime achieved remission of both diseases. The possible pathogenic association of the disorders is discussed.

Adult↗
PubMed2005

Detection of tract formation for prevention of bile peritonitis after T-tube removal. Case report.

Bile leakage after removal of T-tube is a relatively rare complication caused by inadequate tract formation around the tube. We report a case of bile peritonitis after removal of a latex T-tube. The patient underwent reoperation and a new T-tube was introduced. The T-tube was removed six weeks later. Immediately after removal of the tube, the cutaneous ostium of the tube was catheterized with a thin Nelaton catheter. The administration of gastrographin showed the presence of an intact tract. The removal of the t-tube was uneventful. We would propose this method for detecting the tract after removal of the T-tube in order to prevent severe bile leakage after inadequate tract formation.

Aged↗
PubMed2004

Surgical management of cecal diverticulitis: is diverticulectomy enough?

INTRODUCTION: Cecal diverticulitis is a rare condition in the western population. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We present our experience of the surgical management of eight cases of cecal diverticulitis over a 25-year period. PATIENTS AND METHODS: The mean age of the patients was 54.2 years. Five patients underwent diverticulectomy, 2 patients underwent ileocecal resection, and 1 patient underwent suture of the perforated diverticulum. RESULTS: The postoperative course of all patients was uneventful. At long-term follow-up (mean 14.6 years, range 1-25 years) none of the patients who underwent diverticulectomy, mentioned any symptom or complication. CONCLUSION: We conclude that diverticulectomy, if technically feasible, could be considered as adequate therapy for cecal diverticulitis. Aggressive resection should be considered in cases of extensive inflammatory changes.

Adult↗
PubMed2004

"Pes anserinus" of the right phrenic nerve innervating the serous membrane of the liver: a case report (anatomical study).

During the preparations of cadavers for educational purposes we followed the course of the right phrenic nerve. On one of them and especially a female cadaver aged 72-year-old we found a branch arising from the thoracic portion of the right phrenic and passing through the two layers of the falciform ligament distributed to the upper surface of the serous layer of the liver in the form of "pes anserinus". As it is known, pain referred from the diaphragmatic peritoneum is classically felt in the shoulder tip but pain from thoracic surfaces supplied by the phrenic nerve is usually located there albeit vaguely. We believe that the above anatomical finding is the explanation of distinct radiating pain from the hepatic region to the right shoulder in some patients. The stimulations is carried through the phrenic nerve to the fourth cervical neurotome from were arise the supraclavicular nerves which are distributed to the shoulder region.

Aged↗
PubMed2004

Coronary sinus venoarterial CO2 difference in different hemodynamic states.

Myocardial metabolic rate and coronary flow are closely related limiting thus the diagnostic value of coronary sinus saturation monitoring as an indicator of flow. Regional venoarterial CO2 gradient was found elevated during low flow in various clinical and experimental conditions, in animals and humans. This study was undertaken to examine the impact of the variations of cardiac mechanical work on veno-arterial CO2 content and partial pressure difference (deltaPCO2) of the coronary sinus blood. Twenty-seven patients of either sex (m/f = 21/6), undergoing coronary artery bypass grafting under extracorporeal circulation, were studied. Monitoring included a Swan-Ganz catheter and a coronary sinus line. The correct position of the late was verified by the waveform displayed in the monitor. Immediately after cannulae placement, a hemodynamic profile was obtained and simultaneous arterial and coronary sinus sampling for blood gas analysis was done in an ABL 720 (Radiometer Copenhagen) analyzer. A second collection of the same data was obtained five minutes later with the patients in a slight "head-down" position. Conditions for exclusion was intersample variation of hemoglobin's concentration greater than 15% and sodium ion concentration difference greater than 10% of the greater value. Arteriovenous oxygen partial pressure difference (deltaP(a-cs)O2), veno-arterial carbon dioxide partial pressure difference (deltaP(cs-a)CO2), O2 & CO2 content difference and heart's respiratory quotient were calculated and correlated to cardiac output (CO) and the other hemodynamic parameters. Statistical analysis employed t-paired test and linear regression. No ischemia was detected during sampling. "Head-down" position had a significant impact to all hemodynamic parameters except heart rate. In both data rows, although CO ranged widely and altered significantly, coronary sinus oxygen saturation and arteriovenous O2 content difference were stable and showed insignificant correlations to all the hemodynamic parameters that were studied. Carbon dioxide content difference (coronary sinus-arterial) showed a trending of decrease with higher flow. DeltaP(cs-a)CO2 appeared stable and independent of flow. Finally, respiratory quotient decreased significantly from 0.91 +/- 0.4 to 0.86 +/- 0.4 (mean +/- SD; p < 0.05). The heart's high basal oxygen consumption and the almost near hemoglobin's desaturation transcoronary extraction of oxygen limits the value of coronary sinus saturation monitoring as indicator of coronary flow. Heart's little extraction reserve is faced with coronary flow reserve. In the physiologic range and under the conditions of anesthesia, elevated CO2 production is accompanied with increased coronary flow. Under these circumstances, deltaP(cs-a)CO2 appears stable and is not suitable for clinical decisions concerning heart's coronary flow.

Aged↗
PubMed2003

Study of the carrying angle of the human elbow joint in full extension: a morphometric analysis.

This study measured the carrying angle of the elbow joint in full extension in 600 students, using the supplementary angle to that between the longitudinal axis of the arm and that of the forearm. The mean carrying angle was 12.88 degrees +/-5.92: 10.97 degrees +/-4.27 in men and 15.07 degrees +/-4.95 in women. The carrying angle changes with skeletal growth and maturity. The angle is always greater on the side of the dominant hand. We confirmed the inverse relationship between the carrying angle and the intertrochanteric diameter. Also, the type of constitution influences the value of the carrying angle, especially in women.

Adolescent↗
PubMed2003

Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy.

BACKGROUND: Postoperative pain is less intense after laparoscopic surgery than after open surgery. However, patients may gain additional benefit from a preincisional local infiltration of anesthetic. The aim of this study was to compare the analgesic efficacy of two local anesthetics, ropivacaine and levobupivacaine, for tissue infiltration as a means of improving postoperative pain control after laparoscopic cholecystectomy. METHODS: Using a randomized, double-blind study design, 57 American Society of Anesthesiologists (ASA) I and II patients scheduled for laparoscopic cholecystectomy were randomly assigned to receive local infiltration with 0.9% saline solution (Placebo group, n = 18), ropivacaine 1% (Rop group, n = 20), or levobupivacaine 0.5% (Lev group, n = 19). The local anesthetic was administered, prior to trocar placement, using the same technique and delivering the same volume (20 ml) for all three groups. The anesthetic technique was standardized for all groups. Postoperative pain was rated at 2 h, 4 h, and 24 h postoperatively by visual analogue scale (VAS) score. Cumulative analgesic consumption and adverse effects were also recorded. Data were analyzed by analysis of variance (ANOVA), followed by a post hoc test. RESULTS: The Lev and Rop groups did not differ significantly in their VAS scores at 2 h postoperatively, but the Lev group experienced significantly ( p < 0.001) less pain than the Placebo and Rop groups at 4 h and 24 h postoperatively. The Rop group registered significantly lower VAS scores ( p < 0.001) than the Placebo group at 4 h postoperatively. Additionally, the consumption of analgesics was significantly lower in the Lev group than in the Rop ( p < 0.01) and Placebo ( p < 0.001) groups, and patients in the Rop group consumed significantly less analgesics ( p < 0.001) than the to patients in the Placebo group. CONCLUSION: Local tissue infiltration with levobupivacaine is more effective than ropivacaine in reducing the postoperative pain associated with laparoscopic cholecystectomy.

Adult↗
PubMed2003

Splenectomy versus spleen-preserving surgery for splenic echinococcosis.

BACKGROUND/AIMS: The spleen is the third most common location of hydatid disease after liver and lung. The aim of this study was to analyse the long-term outcome of surgical treatment of patients with splenic echinococcosis comparing splenectomy with spleen-preserving surgery. METHODS: During a period of 25 years (1976-2001), 19 (5.4%) patients with splenic echinococcosis were treated in our department out of 349 patients with abdominal hydatid disease. In 16 patients the spleen was the only organ involved, while in 3 patients the liver was also affected. RESULTS: Eleven patients had splenectomy and in the other 8 the spleen was preserved: enucleation (n = 4), partial cystectomy and omentoplasty (n = 2) and cystojejunal Roux-en-Y anastomosis (n = 2). One (6%) patient died in the early postoperative period and 5 (29%) patients had postoperative complications. There was no significant difference between the splenectomy and spleen-preserving groups concerning median hospital stay and postoperative complication rate. The median follow-up in 15 patients was 52 (range 6-300) months. Two patients (13%) developed recurrence of the disease requiring re-operation at 2 and 3 years, respectively. Recurrence occurred in 1 (12%) patient in the splenectomy group and in 1 (14%) out of 7 patients in the spleen-preserving group. CONCLUSION: In the present series it was possible to preserve the spleen in 8 (42%) of 19 patients, without significant increase of recurrent echinococcosis.

Adult↗
PubMed2003

The effect of indwelling endoprosthesis on stone size or fragmentation after long-term treatment with biliary stenting for large stones.

BACKGROUND: Endoscopic biliary stenting is often used for large or difficult common bile duct (CBD) stones, but the effect of indwelling endoprosthesis on size or fragmentation of stones after long-term treatment with biliary stenting has not been formally established. We compared the stone size or fragmentation of common bile duct stones after a long period of biliary stenting. METHODS: Endoscopic biliary endoprosthesis was performed for 49 high-risk patients with CBD stones too large or difficult to be extracted by conventional endoscopic means. Bile duct drainage was established in all the patients without complications. Of the patients, 24 died with endoprosthesis in situ all from causes unrelated to biliar disease; 22 underwent a second and three patients a third attempt at stone extraction. The largest stone diameter was >12 mm in all patients. RESULTS: In 11 of 25 patients (44%) the endoprosthesis allowed resolution of the problem of unextractable common bile duct stones. Four patients showed no existence of stent, and ERCP complete stone clearance from the CBD on programmized appointment after endoprosthesis insertion. Reduced size or fragmentation of stones was obtained in seven patients, and the stones could be removed endoscopically. The remaining 14 patients demonstrated no significant change in the size or fragmentation of their stones, and endoprostheses were replaced. CONCLUSIONS: These results suggest that endoscopic endoprosthesis for large or difficult CBD stones is an effective method to clear the duct in selected cases, as well as an important definitive treatment in high-risk patients.

Adolescent↗
PubMed2003

Hemolysis caused by G-6PD deficiency after a difficult and prolonged therapeutic endoscopic retrograde cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP), together with its substantial therapeutic capabilities, carries a higher potential for complications than other endoscopic procedures. Common major complications specific to pancreaticobiliary instrumentation include pancreatitis, post-sphincterotomy hemorrhage, perforation, and cholangitis with or without systemic sepsis. Two patients underwent therapeutic ERCP for recurrent episodes of abdominal pain and elevation of hepatobiliary enzymes. Endoscopic sphincterotomy was difficult and prolonged. The calculi were successfully extracted by sweeping the choledochus with a balloon-tipped catheter or basket in both cases. The patients experienced postprocedure diffuse abdominal pain unassociated with nausea or vomiting. Laboratory data showed normal serum amylase and lipase 2, 6, and 18 h after the end of procedure, a fall in hematocrit level, and an increase of indirect bilirubin and lactic dehydrogenase. The abdominal pain subsided in 4 to 6 h. The hematocrit level remained stable during the next 3 days, and the patients were very well when discharged. Examination of glucose-6-phosphate dehydrogenase (G-6PD) enzyme levels in red cells 20 days later showed complete enzyme deficiency. This report highlights the importance of examining G-6PD deficiency in patients with post-ERCP abdominal pain, normal serum amylase and lipase, and laboratory findings of hemolysis.

Abdominal Pain↗
PubMed2003

Intrahepatic lithiasis as a late complication of hepaticojejunostomy.

The development of intrahepatic lithiasis proximal to a bilodigestive anastomosis is rare. We report a case of intrahepatic lithiasis of the right hepatic duct, which developed almost 6 years after a hepaticojejunostomy performed for an iatrogenic lesion of the common hepatic duct. The patient experienced repeated episodes of acute cholangitis and was treated with intracorporeal lithotripsy and dilation of the stenosis.

Aged↗