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Biomedical subjects

D Pertsemlidis

Publications and source records attributed to D Pertsemlidis.

At least 19 recordsLinked to original sources
PubMed2001

Diagnostic and interventional laparoscopy and intraoperative ultrasonography in the management of pancreatic disease.

The laparoscopic management of pancreatic disorders has evolved dramatically from its inception in 1911 and its rediscovery in the 1970s. Although investigators once proclaimed that "it seems unlikely that laparoscopy will have any more than an extremely limited use in the investigation of pancreatic disorders," laparoscopy and LUS now have a well-recognized role in the staging of pancreatic cancer and an increasing part in the management of benign pancreatic disease at many institutions. Although the appropriate role of LS and LUS is debatable, the development and refinement of laparoscopic techniques and instrumentation and the improvement of noninvasive diagnostic modalities will provide new data, increase the rate of resection at laparotomy, and allow surgeons to treat a broader range of pancreatic disease by minimally invasive methods. The value of LS and LUS for benign and malignant pancreatic disorders has been clearly demonstrated, but the inevitable issues of hospital resource, operative expertise, and surgical philosophy will ultimately determine the role of laparoscopy and LUS in clinical practice.

Angiography↗
PubMed2000

Pheochromocytoma: inherited associations, bilaterality, and cortex preservation.

BACKGROUND: Hereditary pheochromocytoma (HP) is characterized by early onset, bilateral adrenal involvement, low malignancy rate, and genetic linkage with certain familial syndromes. This retrospective review is intended to show the high yield of surveillance, predictable bilaterality, and the challenge of cortex-sparing adrenalectomy. METHODS: From 1964 to 1999, 32 patients with HP were treated at a single institution and followed for a mean of 7 years. There were 15 cases of multiple endocrine neoplasia type 2A (MEN 2A), 12 cases of von Hippel-Lindau (VHL) disease, 3 cases of von Recklinghausen's disease (VRD), and 2 cases of familial pheochromocytoma. Twenty-four of 32 patients underwent bilateral adrenalectomy (9 metachronous). Subtotal resection with orthotopic cortex preservation was performed in 5 patients, and heterotopic autografting was performed in 14 patients. RESULTS: Pheochromocytoma was the first manifestation in 50% of patients with VHL disease and in 27% of patients with MEN 2A. Surveillance uncovered medullary thyroid cancer in 5 of 15 patients with MEN 2A and hemangioblastomas, renal cell carcinoma, and islet cell tumors in 7 of 15 patients with VHL disease and VRD. HP was bilateral in 24 of 32 patients (14/15 in patients with MEN 2A, 7/12 in patients with VHL disease, 2/3 in patients with VRD, and 1/2 in patients with familial pheochromocytoma). In 9 cases of metachronous adrenalectomy, the mean interval was 67 months (range, 9-156 months). Three of 5 patients who underwent orthotopic preservation of the adrenal cortex experienced recurrence compared with 0 of 14 patients with heterotopic autotransplantation of cortical tissue. CONCLUSIONS: Pheochromocytoma frequently heralds coexisting silent VHL disease or MEN-2, mandating surveillance for inherited associations. The long interval of metachronous pheochromocytoma argues against prophylactic removal of the contralateral "normal" adrenal gland. Total adrenalectomy and heterotopic autotransplantation of medulla-free cortex may diminish the need for lifelong steroid substitution and eliminates recurrence.

Adolescent↗
PubMed1999

The fate of the dropped gallstones during laparoscopic cholecystectomy.

Stones can be spilled from the gallbladder during laparoscopic cholecystectomy. These stones can be left in the peritoneal cavity or trapped at the trocar site. The potential late sequel and associated morbidity are not well documented. We reviewed the records of four patients who underwent laparoscopic cholecystectomy at Mount Sinai Medical Center in New York City who suffered from late complications attributed to gallstones left in the peritoneal cavity or abdominal wall. Four patients presented 1-14 months after laparoscopic cholecystectomy with intraabdominal and abdominal wall abscesses. The spillage of gallstones was noticed during the initial operation only in one of the patients. Three patients required laparotomy and open drainage of intraabdominal abscesses with drainage of pus and gallstones after failed attempts at percutaneous drainage. Two patients underwent local exploration of an abdominal wall abscess containing stones. Stones left in the abdominal cavity or trapped in trocar sites after laparoscopic cholecystectomy can cause serious late complications requiring repeated surgical interventions. Every effort should be made in order to avoid spillage of stones during dissection of the gallbladder and cystic duct and during retrieval of the gallbladder through the abdominal wall.

Abdominal Abscess↗
PubMed1998

Recurrent Cushing's syndrome due to recurrent adrenocortical tumor--fragmentation or tumor in ectopic adrenal tissue?

A 33-yr-old woman was found to have Cushing's syndrome due to a left adrenal cortical tumor. The tumor and the surrounding adrenal gland were removed intact and in toto. Four years later, she noticed recurrent symptoms of Cushing's syndrome, and 6 yr postoperatively, an adrenal tumor was demonstrable on computed tomography. Fourteen years after the initial procedure, a left adrenal tumor, presumably arising in ectopic adrenal tissue, was removed with relief of her symptoms of Cushing's syndrome. The site and functional capacity of ectopic adrenal tissues are reviewed.

Adrenal Cortex Neoplasms↗
PubMed1997

Functioning pancreatic acinar cell carcinoma: immunohistochemical and ultrastructural analyses.

Acinar cell carcinoma (ACC) of the pancreas is a rare malignancy accounting for < 1% of pancreatic neoplasms. We report the clinical and biological characteristics of this carcinoma from two cases that were of interest because of their similar presentation: extensive subcutaneous fat necroses from excessive lipase production by these tumors. Immunohistochemical and ultrastructural analyses of both tumors were consistent with an acinar cell line origin. Recognition of the association between subcutaneous panniculitis and pancreatic neoplasm may prevent long delays in the diagnosis and treatment of this malignancy.

Adipose Tissue↗
PubMed1996

Sialosyl-Tn antigen as a marker of gastric cancer progression: an international study.

Sialosyl-Tn, a mucin-associated carbohydrate antigen, is not expressed by normal mucus-producing cells of the stomach but becomes expressed in metaplastic, pre-malignant and malignant gastric tissues. Reports vary as to the frequency of STn expression and its prognostic role in gastric cancer. To determine whether these differences might be due to inter-country variations in gastric cancer biology, we immunohistochemically analyzed 340 gastric cancers from 2 countries at high-risk (high incidence) for gastric cancer (Japan and Chile), one with intermediate risk (Brazil) and one with low-risk (USA). Expression of STn was correlated with clinico-pathological features of the tumors and with cancer-related survival. Regardless of country, the frequency of STn-positive tumors was lower in non-invasive ("early") than in advanced gastric cancer. Consequently, high-risk countries where early gastric cancer is more common demonstrated a lower overall frequency of STn-positive tumors. In all 4 countries, STn expression directly correlated with depth of invasion, stage, and lymph node involvement. In addition, STn expression correlated with a poor prognosis in all 4 countries, but the effect of STn on survival was not independent of tumor stage. Our findings indicate the need to consider the inherent gastric cancer risk and prevalence of early gastric cancer in the study population when reporting frequency of STn expression in gastric cancer. Regardless of country, however, STn expression is a marker of gastric cancer progression suggesting that cancer-associated mucins play a role in the malignant behavior of this tumor.

Aged↗
PubMed1996

Transient false-positive hepatobiliary scan associated with ceftriaxone therapy.

Drug related false-positive hepatobiliary imaging is uncommon. The authors present a case of a 54-year-old woman who was treated with intravenous ceftriaxone for bacterial meningitis. Symptoms of acute cholecystitis subsequently developed and a sonogram revealed a gallstone. A Tc-99m DISIDA hepatobiliary study was positive for cystic duct obstruction. After discontinuation of ceftriaxone, the patient's clinical condition improved and, 2 weeks later, a repeat hepatobiliary scan was normal. High doses of ceftriaxone and prolonged administration may lead to formation of pseudocholelithiasis and signs of acute cholecystitis. Although this condition is usually benign and reversible, discontinuation of the drug is warranted when symptoms of acute cholecystitis are accompanied by a positive hepatobiliary scan.

Ceftriaxone↗
PubMed1993

Histopathological determinants of survival in resected cases of pancreas cancer.

We have examined the histopathological factors affecting the degree of local spread, regional lymph node (RLN) metastases, and overall survival (O.S.) in a group of 39 cases of resected carcinoma of the exocrine pancreas. Although the mean O.S. for the group was 14.3 months, resected patients without RLN involvement had a mean survival of 24 months. In contrast the mean O.S. rate was 8 months for patients with RLNs involved. Size, tumor location, and histological grade were compared to RLN involvement and O.S. The mean size of primary tumor did not differ significantly between patients with or without RLN's (r.1 versus 4.6 cms). However, 7 or 8 T1 tumors were < 4 cm and 35% of tumors < 4 cm were T1 lesions. In contrast, only 1 of 17 tumors (6%) > 4 cm was T1. Histological grade was correlated with nodal status and O.S. There was a significant difference between histological grade and the presence of metastatic lymph nodes (G1, 37% positive, G2-4.50% positive). Patients with well differentiated tumors had a mean survival of 21 months compared to a mean survival of 10 months for less differentiated tumors (p < 0.05). This difference was even more significant when stratified for nodal status. The patients with well differentiated tumors and no RLN involvement had a mean survival of 32.5 months compared to 8.6 months for well differentiated tumors with RLN involvement. In summary, we have shown that size, histological grade, and local spread predict for nodal status. However, specific patient subsets (G1, node negative) may exhibit an excellent survival when curative pancreas resection is successful.

Actuarial Analysis↗
PubMed1993

Morphometric analysis of benign and malignant adrenal pheochromocytomas.

At present, there are no reliable histologic features that can predict malignancy in adrenal pheochromocytomas other than the documentation of metastases. With the use of computerized interactive morphometry, our aim was to assess nuclei from tissue sections of confirmed cases of benign and malignant pheochromocytomas to determine whether consistent quantitative differences existed between the two. Eight benign cases with at least a 5-year follow-up and nine malignant cases with documented metastases were evaluated. Size distribution plots of the maximum nuclear cord length and of the nuclear area showed a narrow peak for the malignant cases, whereas benign cases showed a right-shifted curve with a wider peak. We concluded that nuclear morphometric analysis of benign and malignant pheochromocytomas yields two distinctive patterns and may be of utility in the assessment of future cases.

Adrenal Gland Neoplasms↗
PubMed1991

S100 protein-positive sustentacular cells in malignant and locally aggressive adrenal pheochromocytomas.

The absence or presence of S100-positive sustentacular cells has been previously shown to be correlated with benign and malignant pheochromocytomas and paragangliomas. We evaluated a total of 17 malignant and recurrent or locally aggressive adrenal pheochromocytomas for their quantity of sustentacular cells. An absence of sustentacular cells was demonstrated in the majority of malignant cases, while the locally aggressive or recurrent group usually contained an abundance of these cells. However, in one malignant case a constant moderate number of sustentacular cells in the primary site and in two sequential metastases was found. We conclude that the absence of sustentacular cells in pheochromocytomas may indicate a lesion with a greater potential for metastasis and that sustentacular cells, when they are present in a malignant pheochromocytoma, are an integral part of the tumor.

Adolescent↗
PubMed1990

Lipid degeneration in a pheochromocytoma histologically mimicking an adrenal cortical tumor.

A recurrent adrenal pheochromocytoma is reported in an 18-year-old woman with a family history of multiple endocrine neoplasia type IIA. The tumor was noteworthy for the presence of numerous fine intracytoplasmic lipid droplets confirmed by fat stain. Immunohistochemical studies revealed cytoplasmic positivity for chromogranin and neuron-specific enolase typical of pheochromocytoma. Electron microscopy demonstrated dense-core neurosecretory granules, in addition to the cytoplasmic lipid vacuoles. The presence of lipid within an adrenal pheochromocytoma is rare and, to our knowledge, has been documented in only one previous case report in the literature.

Adolescent↗
PubMed1986

Association between prognosis and hormone receptors in women with breast cancer.

Axillary node involvement, hormone receptors, tumor differentiation, and obesity have been linked to breast cancer prognosis. We have evaluated which of these factors have an independent association with disease-free survival using the Cox Proportional Hazards model. The study was carried out in 377 patients with breast cancer who underwent mastectomy and axillary node dissection between 1977 and 1984. In the univariate analysis all of the above factors were associated with differences in disease-free survival, and all entered the stepwise model. Among women with negative nodes and those with one to three positive nodes, tumor differentiation was a significant indicator of prognosis, while hormone receptors did not have prognostic significance. The opposite was noted in women with four or more involved nodes, among whom negative hormone receptors was the only significant marker of poor prognosis together with presence of obesity. Among young women node involvement and hormone receptors were significant prognostic indicators, while among older women all four variables were independent prognostic markers. These results indicate a marked heterogeneity among subgroups of women with breast cancer in relation to prognostic markers.

Adult↗
PubMed1983

Fecal steroid excretion and degradation and breast cancer stage.

Evaluation of excretion and degradation of fecal steroids in 74 women with breast cancer in relation to stage, tumor size, and histopathologic nodal status revealed significant differences in relation to stage of disease and tumor size. The level of total fecal steroids (mean +/- SD in mg/g dry wt) in patients with Stage I disease was 40 + 20, Stage II = 56 +/- 32, and Stage III = 75 +/- 57 (P = 0.006). Secondary fecal steroids in women with Stage I disease were 26 +/- 16, Stage II = 40 +/- 27, and Stage III = 57 +/- 34 (P = 0.003). Fecal steroid excretion and degradation was significantly higher in women with larger tumors, whereas nodal status did not contribute to observed differences indicating that dissemination of disease did not influence the results. These differences were noted to be independent of obesity since similar patterns of fecal steroid excretion were noted within the subgroups of both lean and obese women. Increased levels of total fecal steroids and secondary compounds apparently contribute to tumor promotion and may reflect a potential for excess estrogen synthesis since intestinal bacteria have the ability to synthesize estradiol, estrone, and 3,17-methoxyestradiol from secondary steroids present in the colon.

Breast Neoplasms↗
PubMed1983

Monooctanoin dissolution of retained biliary stones in high risk patients.

Monooctanoin, a cholesterol solvent, was infused into the biliary tracts of six high risk patients, in an attempt to dissolve retained stones. The infusion rate was constant, 5-10 ml/h. The mean age of the patients was 76 years. Associated medical conditions were primarily cardiac in nature. Duration of infusion averaged 6 days. In two patients, the stones were completely dissolved. One patient was reoperated despite the stones appearing smaller after 6 days of infusion. At surgery, no stones were found. Two patients in whom dissolution was unsuccessful underwent reoperation. In both, retrieved stones were composed of less than 5% cholesterol. Five of the six patients experienced at least one episode of mild abdominal pain and vomiting. None developed cholangitis, pancreatitis, or significant biochemical abnormalities. Two of the three who underwent reoperation tolerated it without difficulty. While mechanical extraction, when feasible, is still the treatment of choice for retained biliary stones, chemical dissolution should be attempted before undertaking reoperation.

Abdomen↗
PubMed1982

Fecal steroid metabolites and breast cancer risk.

Women with breast cancer (n = 78) had a higher excretion of total fecal steroids in mg/gm of dry weight (56 + 37) compared to controls (45 + 29; n = 71) (P = 0.03). Increases in both total neutral steroids and total bile acids in cases contributed to this significant difference. Lean women (Quetelet's index less than 3.5) with breast cancer seemed to have inappropriately high excretion of total fecal steroids (56 +/- 35), which was significantly higher than that of controls (41 +/- 27) (P = 0.03). Obesity resulted in higher excretion of fecal steroids only in controls. The differences persisted, even after pairing control cases for race-ethnicity and menopausal status. In 59 such pairs, cases had higher values (56 +/- 33), compared to controls (41 +/- 26) (P = 0.008). Significant differences (P = 0.005) were also present in 24 postmenopausal pairs, while in 35 premenopausal pairs a similar trend, but no significant differences were noted. Women with benign breast disease had higher total fecal steroids (51 +/- 34) compared to other controls (38 +/- 21) (P = 0.05). This observation suggests a common etiology between benign breast disease and breast cancer. There were no significant differences in dietary intake of total calories, total fat or dietary cholesterol between controls and cases suggesting that the observed differences in fecal steroids could be attributed to higher endogenous synthesis of cholesterol in cases.

Bile Acids and Salts↗