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D D Karavias

Publications and source records attributed to D D Karavias.

13 recordsLinked to original sources
PubMed2002

Liver resection for metastatic non-colorectal non-neuroendocrine hepatic neoplasms.

AIMS: Major liver surgery can be performed safely and hepatic resection for metastatic disease is increasingly carried out. However, the role of liver resection for hepatic metastases from non-colorectal, non-neuroendocrine (NCNN) cancers is unknown. Our aim was to evaluate our experience from hepatectomies for NCNN metastases. A retrospective study of 170 patients with liver resection performed the last 8 years was performed in two liver units in affiliated university hospitals. METHODS: Eighteen patients underwent liver resection for NCNN tumours. Origins included kidney (n=6), breast (n=4), gastric tumours (n=4), intestinal leiomyosarcoma (n=2) and malignant melanoma and in one patient a metastatic papillary of unknown origin was found. Eleven patients underwent a hepatic lobectomy and seven had local resections. Ten hepatectomies were performed at the same time with the primary tumour resection (synchronous resections) with five of those in an en bloc fashion with the primary tumour. RESULTS: There were no post-operative deaths and the peri-operative morbidity was minimal. During a median follow-up time of 3.2 years, 14 patients are alive with one of them having developed pulmonary metastases. CONCLUSION: In carefully selected patients with NCNN liver metastasis, liver resection can prolong survival as well and improve quality of life.

Adult↗
PubMed2002

Gastrografin administration in the treatment of postoperative delayed gastric emptying.

Five cases of delayed gastric emptying (DGE) are reported. Three patients had pancreatic head carcinoma and underwent a Whipple operation during which truncal vagotomy and gastrectomy were performed. The remaining two patients underwent vagotomy and gastrectomy because of benign peptic ulcer. In one of the pancreatectomy cases, the pylorus was at first preserved, but after DGE developed, a gastrectomy was carried out, which did not result in any improvement. The duration of DGE was 16-72 days, during which time the patients were under total parenteral or enteral nutrition. There were no other major complications. The patients received prokinetic agents (metoclopramide, erythromycin) but without any improvement. Finally, all patients were treated with Gastrografin, 40 ml every two hours, via a nasogastric tube. In all cases, gastric motility was restored within 20-36 hours.

Contrast Media↗
PubMed2000

Pancreatic carcinoma is characterized by elevated content of hyaluronan and chondroitin sulfate with altered disaccharide composition.

The amount and the types of glycosaminoglycans (GAGs) present in human pancreatic carcinoma were examined and compared with those in normal pancreas. Human pancreatic carcinoma contained increased levels (4-fold) of total GAGs. Particularly, this carcinoma is characterized by a 12-fold increase of hyaluronan (HA) and a 22-fold increase in chondroitin sulfate (CS) content. CS in pancreatic carcinoma exhibited an altered disaccharide composition which is associated with marked increase of non-sulfated and 6-sulfated disaccharides. Dermatan sulfate (DS) was also increased (1.5-fold) in carcinoma, whereas heparan sulfate (HS), the major GAG of normal pancreas, becomes the minor GAG in pancreatic carcinoma without significant changes in the content and in molecular size. In all cases, the galactosaminoglycans (GalGAGs, i.e. CS and DS) derived from pancreatic carcinomas were of lower molecular size compared to those from normal pancreas. The results in this study indicate, for the first time, that human pancreatic carcinoma is characterized by highly increased amounts of HA and of a structurally altered CS.

Carbohydrate Sequence↗
PubMed2000

Relative risk of cancer in sonographically detected thyroid nodules with calcifications.

PURPOSE: The aim of this prospective study was to evaluate the significance of sonographically detected thyroid calcifications in the diagnosis of thyroid cancer. METHODS: One hundred eighty-eight patients with thyroid disease, including 37 with thyroid cancer, were included in the study. Each patient underwent preoperative, high-resolution sonography to evaluate the thyroid gland for the presence of calcifications. RESULTS: The highest incidence of calcification was found in thyroid cancer (54%), followed by multinodular goiter (40%), solitary nodular goiter (14%), and follicular adenomas (12%). The incidence of cancer was significantly higher in calcified nodules (29%) than in noncalcified nodules in the entire group (14%) (p = 0.019), with a relative risk of 2.5. In the group of solitary thyroid nodules, the incidence of cancer in the calcified nodules (55%) was higher than in the nodules without calcification (23%) (p = 0.016). Multiple noncalcified thyroid nodules harbored cancer in only 5% of cases. Compared with multiple noncalcified thyroid nodules, the solitary calcified nodules demonstrated a relative risk of 22.8. In both the solitary and multiple nodules, the relative risk in the presence of calcification was about the same, around 4. Patients younger than 40 years with calcified nodules constituted a high-risk group, with a relative risk of 3.8 versus 2.5 in patients older than 40 years with calcified nodules. CONCLUSIONS: The detection of thyroid calcifications by sonography is diagnostically valuable, especially in cases involving a solitary nodule or a young person. The presence of calcifications in these cases should raise the suspicion of malignancy. The low incidence of cancer in patients with multiple noncalcified thyroid nodules suggests that a more conservative approach may be appropriate in such cases.

Adult↗
PubMed1999

Surgical treatment of non-parasitic hepatic cysts: report of 12 cases.

OBJECTIVE: To present our experience of non-parasitic hepatic cysts. DESIGN: Retrospective study. SETTING: University Hospital, Greece. SUBJECTS: 12 consecutive patients with symptomatic non-parasitic hepatic cysts operated on during the 7-year period 1990-97 inclusive. INTERVENTIONS: Wide unroofing of the hepatic cysts. MAIN OUTCOME MEASURES: Persistence or recurrence of symptoms and recurrence of cysts. RESULTS: Symptoms persisted or recurred in 2/12 patients and cysts recurred in 2/9 who had ultrasound scans. CONCLUSION: Surgical treatment of non-parasitic hepatic cysts was effective and safe.

Adult↗
PubMed1995

Long-term results after liver transplantation for primary hepatic epithelioid hemangioendothelioma.

BACKGROUND: Hepatic epithelioid hemangioendothelioma (PHEHE) is a multifocal, low-grade malignant neoplasia characterized by its epithelial-like appearance and vascular endothelial histogenesis. The outcome of 16 patients treated with orthotopic liver transplantation (OLT) is the subject of this report. METHODS: A retrospective study of 16 patients with HEHE (7 men, 9 women) with ages ranging from 24 to 58 years (mean 37 +/- 10.6 years). Follow-up intervals ranged from 1 to 15 years (median of 4.5 years). RESULTS: Actual patient survival at 1, 3, and 5 years was 100, 87.5, and 71.3%, respectively. Disease-free survival at 1, 3, and 5 years was 81.3, 68.8, and 60.2%, respectively. The 90-day operative mortality was 0. Involvement of the hilar lymph nodes or vascular invasion did not affect survival. The 5-year survival of HEHE compares favorably with that of hepatocellular carcinoma at the same stage (stage 4A): 71.3 versus 9.8% (p = 0.001) CONCLUSIONS: The long-term survival obtained in this series justifies OLT for these tumors even in the presence of limited extrahepatic disease.

Adult↗
PubMed1995

Conservative surgery in the treatment of hepatic hydatidosis.

OBJECTIVE: To examine the morbidity, mortality and recurrence rate after a modified conservative operation in the treatment of hepatic hydatidosis. DESIGN: Prospective open study. SETTING: University hospital, Greece. SUBJECTS: 67 Consecutive patients with hepatic hydatidosis, operated on between 1985 and 1990. INTERVENTION: The liver was mobilised and abdominal cavity isolated with pads soaked in 15% saline solution. Hydatid fluid was aspirated from the cysts which were widely deroofed, sterilised with 15% saline, and then oversewn with a braided absorbable suture. Drains were left in place and a third of patients also had omentoplasty (n = 22). MAIN OUTCOME MEASURES: Morbidity, mortality and recurrence rate. RESULTS: One patient died (1%), 4 developed complications (6%), and there were 3 recurrences (6%). It made no difference whether an omentoplasty was added or not. CONCLUSION: Conservative surgery achieves satisfactory results in the treatment of hepatic hydatidosis.

Adolescent↗
PubMed1992

Improved techniques in the surgical treatment of hepatic hydatidosis.

We evaluated 64 patients with hepatic hydatidosis who were treated during 1982 to 1988. The main clinical manifestations were epigastric pain (84 per cent), hepatomegaly (31 per cent), fever (30 per cent) and jaundice (25 per cent). Five patients were asymptomatic. All diagnoses were established by ultrasonography and computed tomography, or both (sensitivity rates of 95 and 93 per cent, respectively). Treatment was exclusively surgical and there were no deaths. In the five patients in group 1, total cystectomy was done without morbidity. The 19 patients in group 2 underwent a limited capsectomy, evacuation of the cyst, omentoplasty, suturing of the biliary communications and drainage of the residual cavity, with a rate of morbidity of 42 per cent. In the 40 patients in group 3, a wide capsectomy and unroofing of the cyst were done, the contents were removed, the cavity edges were hemostatically oversewn and the residual hepatic cavity was drained through a high vacuum, closed drainage system. Omentoplasty was not routinely done. With this technique, the rate of morbidity was reduced to 2.5 per cent. Of 64 patients, 32 were observed for an average of 42 months with a recurrence rate of 9 per cent. Because of the low rate of postoperative morbidity, recurrence and the shorter period of hospitalization, the surgical technique used in group 3 seems to be an efficient method for hepatic hydatidosis.

Adolescent↗
PubMed1991

Total parenteral nutrition in severe acute pancreatitis.

The influence of total parenteral nutrition (TPN) was studied in 67 patients with severe acute pancreatitis having three or more criteria according to Ranson (mean +/- SD = 3.8 +/- 0.21). Although TPN has been reported to not be of benefit in the progress and severity of the disease, we have found that the time TPN is started is important in influencing the course of the disease and in the development of local complications, as well as in the mortality rate. Patients whose TPN was started within the first 72 hours of the disease had a 23.6% complication rate and 13% mortality, in comparison with patients whose TPN was started later in the course of the disease, who had a 95.6% complication rate (p less than 0.01) and a mortality rate of 38% (p less than 0.03). The nutritional status of the patients during TPN administration of 28.4 days was maintained either steady or was improved, as assessed by nitrogen balance, serum levels of transferrin (p less than 0.05), and albumin (p less than 0.05). The administration of fat solution, either to prevent essential fatty acid deficiency or to provide part of the caloric requirements, was found to cause neither clinical nor laboratory worsening of the disease. All pancreatic fistulae that developed during the course of the disease spontaneously closed in patients receiving TPN without operation in a mean period of 33.3 days, and all pseudocysts subsided in an average of 18.3 days. Those who died (overall mortality rate 24%) had had uncontrollable sepsis, which resulted in hypercatabolism and multiple system organ failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

Peritoneal echinococcosis.

Peritoneal echinococcosis is rare, even in areas where hydatid disease is endemic. Although the liver and lungs are the organs most commonly involved, peritoneal echinococcosis, either primary or secondary, represents an uncommon but significant manifestation of the disease. We reviewed the medical records of 121 patients with abdominal echinococcosis operated on in our department over the past 12 years. Peritoneal echinococcosis was found in 17 patients, usually combined with liver disease. The presenting symptoms were mostly atypical, and a few cases were discovered accidentally during routine follow-up after operations for hepatic echinococcosis. Surgery remains the best curative or palliative treatment for peritoneal echinococcosis, although anthelmintics can be an effective alternative for the treatment of small and asymptomatic cysts.

Adult↗
PubMedDate not supplied

Simple (non-parasitic) liver cysts: clinical presentation and outcome.

Non-parasitic hepatic cysts are frequent and usually asymptomatic. Investigation must differentiate from parasitic or neoplastic cysts. Ultrasonography, computed tomography, magnetic resonance imaging and serology do not always ensure a definitive diagnosis, where as other diagnostic methods offer little assistance. Symptoms, complications or uncertain diagnosis make treatment necessary. Various techniques have been used in management of non-parasitic hepatic cysts. Both surgical and recent minimally invasive methods such as laparoscopy and percutaneous aspiration with sclerotherapy are discussed and evaluated. Treatment of choice or indications for each method remains a controversial subject that requires further study.

Cysts↗
PubMedDate not supplied

Distribution and changes of glycosaminoglycans in neoplasias of rectum.

The content, composition and physicochemical characteristics of glycosaminoglycans in human rectum and rectum carcinoma were investigated by chemical analyses, enzymic treatments, chromatographic and electrophoretic techniques. The overall glycosaminoglycan content was increased about 2 fold in neoplastic tissues compared to nonneoplastic tissues. The absolute amounts of chondroitin sulfate, hyaluronic acid and dermatan sulfate significantly increased but the amounts of heparan sulfate decreased in neoplastic tissues compared with nonneoplastic tissues. In addition an increased fraction of keratan sulfate and undersulfated chondroitin was identified in neoplastic tissues. HPLC analysis of chondroitinase AC and ABC digests showed a marked increase in delta di-6S and delta di-OS disaccharides in tumor chondroitin sulfate, revealing significant alterations on the sulfation pattern. The results indicate that specific glycosaminoglycan alterations occur in human rectum carcinoma and suggest that proteoglycan metabolism is also altered in this carcinoma.

Aged↗