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D Karavias

Publications and source records attributed to D Karavias.

11 recordsLinked to original sources
PubMed1995

Acute pancreatitis after liver transplantation: incidence and contributing factors.

In order to assess the incidence and possible predisposing and contributing factors in the development of acute pancreatitis after liver transplantation, we reviewed the medical records of all 1832 adult patients who underwent 2161 orthotopic liver transplantation (OLTx) procedures in our center between January 1987 and September 1992. Of these patients, 55 (3% incidence) developed clinical pancreatitis and 247 (13.4% incidence) developed hyperamylasemia (biochemical pancratitis). Overall mortality in cases of clinical pancreatitis was 63.6%. The mortality in cases of hyperamylasemia was similar to that found in the general liver transplant population (i.e., 23%). A strong correlation was found between pancreatitis after liver transplantation and end-stage liver disease due to hepatitis B (30% of the cases, P = 0.00001). Extensive surgical dissection around the pancreas (P < 0.05), the type of biliary reconstruction following liver transplantation (P < 0.05), and the number of liver grafts received by the same patient (P = 0.00001) appeared to be possible contributing factors as did the duration of venovenous bypass and the quantity of IV calcium chloride administered intraoperatively.

Acute Disease↗
PubMed1992

Major vascular lesions associated with orthopaedic injuries.

Seventeen patients, aged 11-67 years (mean, 32.6), with major vascular injuries associated with traumatic orthopaedic injuries, were treated operatively in the authors' institution over a 4-year period. The most common mechanism of trauma was a high-energy injury (70.8%), and the rate of open injuries was 88.2%; 64.9% of the injuries were located in the lower extremities. The treatment protocol consisted of aggressive resuscitation; Doppler imaging and, when necessary, angiography; stable bone fixation with subsequent vascular repair; and extended wound debridement. The vascular repair for arterial lacerations consisted of (a) end-to-end anastomosis (47.2%); (b) interpositional homologous vein graft (23.6%); (c) vascular decompression through fracture distraction in one patient (5.9%); (d) xenograft interposition (in one patient; 5.9%); (e) venous repair (in three patients; 17.7%); and (f) embolectomy (in all patients). Three vascular reoperations (17.7%) were necessary because of rupture of the anastomosis. The authors' preferred bone stabilization method was external fixation, which was used in 47.2% of cases. Amputation was performed in three cases (17.7%) as a salvage operation. Although six patients (35.4%) were admitted with delayed shock (mean duration, 73.6 +/- 27.8 min), this led to a lethal outcome due to shock lung in only one patient. Another patient developed massive lung embolism 3 months postoperatively and died. The authors believe that this well-organized approach, based on a specific treatment protocol, for patients with severe orthopaedic trauma and concomitant vascular injury, not only improves outcome but gives good to excellent functional results in the majority of patients.

Adolescent↗
PubMed1988

Infected echinococcal cyst. A common cause of pyogenic hepatic abscess.

Twenty-one cases of hepatic abscesses treated during a period of four years (from 1981 to 1985) at the University of Patras, Greece, are presented. This material includes 10 cases with abscesses caused by suppurated echinococcal cysts, corresponding to 21% of the total number of 47 cases of echinococcal cysts of the liver treated at our department during the same period. A preoperative diagnosis of the suppurated echinococcal cysts by conventional laboratory methods was not reliable. Because of the high frequency of echinococcal disease in our region and the risk of contamination of the peritoneal cavity from echinococcal parasites if the cyst is punctured, the new therapeutic techniques of treating hepatic abscesses by percutaneous drainage have not been applied. The exclusive method of treatment used was surgical drainage which had a satisfactory outcome and a mortality rate as low as 9%.

Adult↗
PubMed1987

Unusual electrocardiographic changes in intrathoracic conditions.

Electrocardiographic, roentgenographic and clinical findings from 5 patients with intrathoracic conditions were studied. Three patients suffering from left spontaneous pneumothorax and one from eventration of the left diaphragm were found to have an unusual phasic voltage alternation in their electrocardiograms. These changes were appearing during the course of the disease and disappearing with the correction of the condition. Respiratory variation of intrathoracic anatomy or amplitude and swinging of the heart seems a possible explanation.

Diaphragmatic Eventration↗
PubMedDate not supplied

Bile leakage following T-tube removal in orthotopic liver transplantation.

BACKGROUND/AIMS: Biliary tract complications constitute a common cause of post-operative morbidity after orthotopic liver transplantation. Bile leakage following T-tube removal, even if uncommon, can also seriously influence post-operative recovery. This report outlines the diagnostic and therapeutic policy used to treat this complication in a large liver transplantation center. METHODOLOGY: Fourteen consecutive cases of bile leakage after T-tube removal are presented. Abdominal pain was the most common symptom and acute abdomen developed in one third of the patients. Ultrasonography was the most common imaging technique used. RESULTS: Five patients were treated conservatively with or without percutaneous drainage of the biloma and 9 patients underwent an exploratory laparotomy. Ligation of the T-tube tract was the most common technique used. All patients had an uneventful clinical course. CONCLUSIONS: Clinical signs are the most important factor in the diagnosis of this complication, and should be treated surgically if the patient does not improve within 24-48 hours under conservative management. Inadequate fibrous T-tube tract formation due to immunosuppression or the underlying disease could be an explanation for the development of this complication.

Bile↗
PubMedDate not supplied

Mesenteric fibromatosis.

Mesenteric fibromatosis is commonly associated with Gardner's syndrome and familial polyposis. These lesions may have an insidious onset via compression of the small or large intestines, or may be noted for the first time during abdominal exploration for some other cause. Differential diagnosis may be difficult. We report a case of mesenteric fibromatosis with two recurrences, and two cases with no evidence of tumour recurrence.

Adult↗