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D Voros

Publications and source records attributed to D Voros.

At least 19 recordsLinked to original sources

Colorectal cancer emergencies during pregnancy case reports.

Colorectal carcinoma emergencies during pregnancy are exceptionally rare. Three women 38, 31 and 36 years old, in the third trimester of gestation received treatment, respectively, for acute abdomen due to perforation of rectal carcinoma, ileus due to a sigmoid tumor, and deep venous thrombosis (DVT) from a cecal tumor compromising the right iliac vein. In the first two patients urgent cesarean sections were carried out with Hartmann's procedure and a loop colostomy was performed to resolve the ensuing intraabdominal sepsis and ileus, respectively. In the third patient, a cesarean section was carried out to treat the underlying DVT more aggressively, while right colectomy was postponed for three weeks. Restoration of the alimentary tract was achieved two months later in the first case, while in the second and third cases total colectomy due to familial polyposis and right colectomy were performed three weeks after the cesarean section. An overview of the clinical features, diagnostic pitfalls and therapeutic approaches to manage complications of colorectal cancer during pregnancy are discussed.

Abdominal Pain↗

Identification of germline BRCA1 and BRCA2 genetic alterations in Greek breast cancer moderate-risk and low-risk individuals--correlation with clinicopathological data.

The current study was designed to evaluate the prevalence of BRCA1 and BRCA2 germline mutations in Greek moderate- and low-risk individuals with respect to clinicopathological phenotype and clinical outcome of breast cancer. Ninety-four consecutive individuals were prospectively recruited from two University Breast Cancer Clinics (Hippokrateion Hospitan and Laikon Hospital) between 1989 and 1999 and were categorized as moderate-risk and low-risk individuals for carrying BRCA1/2 germline mutations. To identify the underlying mutations, protein-truncation test and single-strand conformation polymorphism methods were used, followed by direct sequencing. Three novel BRCA1 missense mutations, one novel BRCA1 intronic deletion, three novel (previously reported) BRCA2 truncating mutations, and one novel BRCA2 missense mutation were identified in the moderate-risk group of individuals studied. The BRCA1/2 missense mutations as well as the single intronic variant identified were designated as unclassified genetic variants. Two BRCA1 unclassified genetic variants (missense mutations) were detected in two of the three (66.7%) male breast cancer patients analyzed, while the third one was identified in a sporadic (low-risk) breast cancer patient. Clinicopathological characteristics of breast carcinomas originating from BRCA1/2 heterozygotes were consistent with those already reported and not different from those observed in BRCA1/2 mutation (-) breast cancer patients. Furthermore, BRCA1/2 mutation carriers presented an excellent 4.5-year overall survival (100%). Our results reveal the unique characteristics of BRCA1/2 mutation status, genotype-phenotype correlations, and prognosis, in moderate- and low-risk individuals of Greek ancestry. Breast cancer due to mutations in BRCA1 and BRCA2 genes appears to be a heterogeneous syndrome in the Greek population.

Adult↗

Leucovorin and fluorouracil vs levamisole and fluorouracil as adjuvant chemotherapy in rectal cancer.

The aim of this study was to evaluate the effectiveness of 6-month therapy with leucovorin (LV) + 5-fluorouracil (5-FU) vs 12 months of therapy with levamisole (LVZ) + 5-FU, as adjuvant chemotherapy in patients with completely resected Dukes' stage B2 or C rectal cancer. One hundred and fifty patients with surgically resected rectal carcinoma, were enrolled in the present study; Dukes' stage B2 (n=70) or C (n=80), were randomly assigned to chemotherapy with 5-FU + LV x 6 months or 5-FU + LVZ x 12 months. Patient characteristics were equally balanced between the examined groups. Adjuvant CT consisted of LV 20 mg/m(2) intravenously (i.v.) plus 5-FU 450 mg/m(2) i.v., on days 1-5 every 4 weeks for 6 cycles or 5-FU 450 mg/m(2) i.v. every week plus LVZ 50 mg t.i.d x 3 days for 1 year. All patients received radiotherapy with a three-field technique to a total dose of 45 Gy, over 5 weeks. After a median follow-up of 7.4 years there were no significant differences between the two treatment groups with respect to the recurrence rates (P=0.821). Moreover, there was no difference in disease-free survival for patients stage Dukes' B2 (log-rank p=0.73); median for LV group 90 (8-131) months, and for LVZ group 86.5 (3-129) months. No difference was noted in disease-free survival for patients stage Dukes' C (log-rank p=0.73); median for LV group 60 (17-128) months, and for LVZ group 64 (2-123) months. There was no difference in overall survival for patients stage Dukes' B2 (log-rank p=0.75); median for LV group 90 (22-131) months, and for LVZ group 86 (10-129) months. For stage Dukes' C (log-rank p=0.73); median for LV group 67 (17-128) months, and for LVZ group 64 (5-123) months. Toxicities were as follows in the 5-FU + LVZ vs 5-FU + LV group; myelosuppression (leucopenia grade 3, 12% vs 4%, p<0.04), diarrhea (grade 0, 60% vs 76%, p<0.02), and liver toxicity (increase of transaminases >3-fold, 12 patients vs 2, p<0.03), were more frequent in LVZ group. None of the patients stopped chemotherapy because of the toxicity, and there were no toxicity-related deaths. In conclusion, adjuvant chemotherapy in RC with LV + 5-FU for 6 months is equally effective and less toxic than LVZ + 5-FU for 12 months.

Adult↗

Surgical adjuvant therapy of rectal carcinoma: a controlled evaluation of leucovorin, 5-fluorouracil and radiation therapy with or without interferon-alpha2b.

BACKGROUND: The aim of this study was to determine whether the efficacy of the combination of 5-fluorouracil (5-FU), leucovorin (LV) and radiation therapy (RT) could be improved by the addition of interferon-alpha2b (IFN-alpha) in patients who have had a 'curative' resection, for rectal adenocarcinoma (Dukes' B2/C; T3 N0, T4 N0, N1-3). PATIENTS AND METHODS: A total of 207 eligible patients with a performance status of 0 or 1 were randomized postoperatively between days 21 and 70 to one of the two treatment groups: group A, LV 20 mg/m2 i.v. bolus and 5-FU 425 mg/m2 i.v. days 1-5 and 29-33, LV 20 mg/m2 and 5-FU 400 mg/m2 days 57-60 and 85-88, LV 20 mg/m2 and 5-FU 380 mg/m2 days 1-5 and 29-33 with the second day 1 occurring 28 days after the completion of RT (45 Gy); group B, LV, 5-FU and RT as in group A, and IFN-alpha 5 x 10(6) IU s.c. three times during each week chemotherapy is given. RESULTS: 104 patients were randomized into group A and 103 into group B. There was no statistically significant difference in either disease-free survival or overall survival between the two groups. Toxicity was also the same, except for the flu-like syndrome associated with the IFN-alpha administration. CONCLUSIONS: There was no difference in efficacy between the two combinations. Toxicity was greater with the LV + 5-FU + IFN-alpha regimen because of the flu-like syndrome.

Adenocarcinoma↗

Fatal wounding of the Byzantine Emperor Julian the Apostate (361-363 A.D.): approach to the contribution of ancient surgery.

Byzantine surgery flourished from the early stages of the Byzantine empire (324-1453 A.D.). The first great Byzantine physicians, among the most eminent being Oribasius from Pergamun (fourth century), not only compiled anthologies of the works of ancient Greek, Alexandrian, and Roman physicians but added their own personal practical experience and observations. The circumstances surrounding, and the treatment of, the fatal abdominal wounding of one of the most renowned emperors of Byzantium, Julian the Apostate (361-363 A.D.), is examined based on historical accounts unknown in the broader medical bibliography, namely, the histories and chronicles of Byzantine writers. From this analysis it can be concluded that the emperor's physician, Oribasius, in all probability, applied knowledge of ancient Greek and Roman surgery to save his famous patient. The techniques of "gastrorrhaphy" and pharmaceutical confrontation of the wound in that era, adopted later by the surgeons of the Medieval West, seem to constitute noteworthy roots of modern surgery.

Abdominal Injuries↗

Imbalance of demand and supply for regionalized injury services: a case study in Greece.

OBJECTIVE(S): To study regionalized acute injury services on an island with high seasonal fluctuation of the population at risk. STUDY PARTICIPANTS: Of 9432 individuals with traumatic injuries who contacted the hospital during 1996, 1204 were hospitalized. Information was recorded on several injury-related clinical and sociodemographic variables. Possible residual disabilities, 6 months after the injury, were also assessed. MAIN OUTCOME MEASURES: Injury Severity Score (ISS), clinical outcome and duration of hospitalization, odds of transfer to other institutions. RESULTS: Non-residents, whether Greek or foreign nationals are hospitalized for shorter periods. Motor vehicle accident victims are hospitalized on average for 15% longer. Injury victims admitted on a Friday are hospitalized for a longer period. Finally, ISS is a powerful positive predictor of duration of hospitalization. Male injury victims, those injured during late night or early morning and patients injured in July are more likely to be transferred to another institution. Age of the patient and ISS are powerful and independent predictors of an unfavourable outcome. CONCLUSION: The extra demand created by injured tourists is reflected in the seasonality of admissions for injuries. The district hospital of Kerkyra cannot be considered as deficient in comparison to other district hospitals. Nevertheless, the suboptimal function of the hospital, with respect to injuries, is reflected in the high proportion of injured patients transferred when the injury occurs outside the full working schedule of the hospital. Patients with burns, bone fractures or dislocations and head injuries or concussion are transferred with an overall frequency of about 15%--too high to be compatible with a well functioning secondary care institution.

Adolescent↗

Splenic abscess. An old disease with new interest.

BACKGROUND/AIMS: To study the demographics, signs and symptoms, causes, risk factors, imaging findings, bacteriologic profile, treatment and outcome of patients with splenic abscess. METHOD: The medical records of 17 patients with splenic abscess at two tertiary-care hospitals between 1989 and 1997 were retrospectively reviewed. The demographic data, physical and radiological findings, treatment, bacteriology reports and outcome of treatment were reviewed. RESULTS: The mean age of patients was 43 years (range 7-79 years). Fever and abdominal pain were the most prominent signs. Seven patients were immunocompromised, three had abscessed hydatic cysts, two were drug users and three suffered from splenic trauma, infarction, and endocarditis, respectively. No predisposing factor was identified in 2 patients. In all cases, CT demonstrated the splenic lesion(s). Staphylococcus species and Bacteriodes were the most common microbes, identified in the blood and abscess cultures. Thirteen patients underwent splenectomy, two medical therapy and two no therapy with respective survival rates of 92, 100 and 0%. CONCLUSION: Splenic abscess is a rare surgical entity encountered mostly in immunocompromised patients. CT scan is the gold standard for the definite diagnosis. Splenectomy is the treatment of choice, while medical therapy should be reserved for unusual pathogens provided that an effective antimicrobial agent is available.

Abdominal Abscess↗

Duodenal gangliocytic paraganglioma as a radiological moving defect.

BACKGROUND: Gangliocytic paraganglioma of the duodenum is a peculiar neuroendocrine tumor, often revealed as an incidental radiographic finding or as a result of gastrointestinal hemorrhage, due to frequent ulceration of the overlying mucosa. Most lesions are pedunculated and submucosal with distinctive histology, consisting of endocrine, ganglion and spindle-shaped Schwann cells. METHODS: A case of a duodenal gangliocytic paraganglioma is reported in a 50-year-old woman presenting with episodes of melena. Enteroclysis revealed a pedunculated tumor observed either in the second or third portion of the duodenum. Upper gastrointestinal endoscopy revealed a pedunculated ulcerated tumor which was subsequently confirmed by computed tomography. The tumor was simply excised through a duodenotomy. RESULTS: The size of the tumor was 4.5 x 3 x 1.5 cm. Immunohistochemical and ultrastructural features of the tumor classified it as a typical duodenal gangliocytic paraganglioma with positive cellular reaction for neuron-specific enolase, chromogranin, somatostatin, gastrin and S100. CONCLUSION: Forty-six months after surgery, the patient is well with no evidence of recurrence. The majority of the reported duodenal gangliocytic paragangliomas were of benign nature. However, the fact that in 4 isolated cases there was lymph node involvement indicates that thorough investigation for lymph node metastases is needed, as well as thorough postoperative follow-up.

Duodenal Neoplasms↗

Effects of prolonged stay in hospital on gastric flora.

OBJECTIVE: To find out if a long preoperative stay in hospital results in the introduction of micro-organisms into the gastric flora that are resistant to the usual perioperative chemoprophylaxis. DESIGN: Observational study. SETTING: Teaching hospital, Greece. SUBJECTS: 145 consecutive patients admitted for abdominal or pelvic operations. INTERVENTIONS: Aspiration of gastric fluid for measurement of pH and culture. MAIN OUTCOME MEASURES: Growth and type of pathogens in gastric aspirate. RESULTS: 125 patients spent a mean (range) of 13.6 days (7-69) in hospital preoperatively and 20 patients spent 3.1 (1-7) days. In the long-stay group 103 had a gastric pH of <4 and in 22 it was 4 or more; in 40 patients pathogens were grown from the gastric aspirate but resistant Pseudomonas cepacia was grown from only 2. In the short-stay group 16 patients had a pH of <4 and in 4 it was 4 or more; in 4 patients pathogens were grown from the aspirate. CONCLUSION: Prolonged stay in hospital preoperatively does not seem to affect the gastric flora, so routine chemoprophylaxis should be sufficient in abdominal operations.

Adult↗

The real incidence of extracapsular (satellite) cysts of liver echinococcus.

BACKGROUND: The presence of extracapsular (Satellite) cysts in liver echinococcus granulosus is known for many years. In one of our previous studies of radiological (CT) material they were found to be present in 16% of cases. METHODS: In the present study the operative findings, in cases of total capsectomy (cystopericystectomy) or partial lobectomy are presented. RESULTS: The real incidence of these cysts in operative specimens was as high as 29,5%. They were present in 15 out of 51 totally excised cysts. CONCLUSIONS: We conclude that satellite cysts are present more often than they are radiologically detected. As they can be incriminated as a cause of recurrence of the disease they must be excised en block with the main parasitic cysts, by means of more radical procedures such as cystopericystectomy or partial hepatectomy, whenever it is feasible.

Adolescent↗

Retroperitoneal tumors: do the satellite tumors mean something?

BACKGROUND AND OBJECTIVES: Primary retroperitoneal tumors constitute a rather uncommon disease with an incidence of 2 in 100,000. Local recurrence after surgical resection is reported between 60% and 90% at 10 yr. The aim of this study was to present the problem of satellite tumors around the main tumor mass and their possible relation to local recurrence. METHODS: Twenty-nine patients with retroperitoneal tumors underwent surgical resection in our department during an 8-yr period. We reviewed their records including their preoperative computed tomography (CT) scans. RESULTS: Twenty patients had "complete" resections requiring seven nephrectomies, four colectomies, two splenectomies, and one appendectomy. In nine cases the resection was incomplete because of tumor invasion to vital structures. Histopathology revealed that the resected tumors were: liposarcomas (12), leiomyosarcomas (4), paragangliomas (5), malignant fibrous histiocytomas (3), other sarcomas (3), schwannoma (1), myelolipoma (1), and the malignancy grade was I in 6, grade II in 11, and grade III in 12 cases. Two patients died within 30 d of the operation. The I year recurrence rate was 41.4% (12/29) and the total recurrence rate 55.2% (16/29). Survival at 5 yr was 31% (9/29), whereas the disease-free survival was 20.7% (6/29). Four patients required reoperations. In seven cases (24,1%) preoperative CT scans revealed small nodular lesions around the main tumor that were removed en bloc and were of the same histopathological type as the main tumor. We called these "satellite" tumors. All seven patients had local recurrence within 1 yr. CONCLUSIONS: There seems to be a close relationship between the finding of satellite tumors and the recurrence of the disease. The existence of satellite tumors on the preoperative CT scan may be used as a guide for the extent of the resection, and further investigations are necessary before they are used as a prognostic sign.

Adolescent↗

Dissociation of ACTH, beta-endorphin and cortisol in graded sepsis.

The function of the hypothalamic-pituitary-adrenal axis as related to the degree of severity of a septic process was assessed by measuring plasma levels of beta-endorphin, ACTH and cortisol. Sixty-one cases of postoperative patients treated at the intensive care unit were classified into four groups according to the severity of infection: Group 1 (control) included patients who did not show any sign of infection, group 2 patients with sepsis, group 3 patients with septic syndrome and group 4 patients with septic shock. Compared to G1 patients' ACTH values (4.16+/-2.6pg/ml), a statistically significant increase in ACTH values in various stages of septicemia (p < 0.005) with a noticeable difference also between G3 (7.11 +/-3.7pg/ml) and G4 (11.5+/-6.6pg/ml) (p<0.05) was found. Differences were also observed in beta-endorphin (with a level of significance between the several groups of p = 0.0001). Also, beta-endorphin values in G4 (40.6+/-30.3 pg/ml) differed significantly from each of G1 (17.5 +/-6.6 pg/ml), G2 (21.1+/-11.3 pg/ml) and G3 (23.5+/-12 pg/ ml) (p<0.05). A progressive hypercortisolemia was obvious, with values of G4 (37.2+/-15.6 microg/dl) differing significantly from those of G1 (18+/-4.6microg/dl) and G2 (24-/+8.4microg/dl) (p<0.05) and of G3 (28.5+/-12.3 microg/dl) from that of G1 (p < 0.05). Interestingly, a dissociation of ACTH, beta-endorphin and cortisol was observed, in that the increased values of beta-endorphin and cortisol, detected in the G3 were not associated with a parallel increase in ACTH. These findings might be interpreted in the sense of an impairment of the stress stimulation of the hypothalamic pituitary adrenal axis. Provided that such a situation can be lethal, our results further confirm the idea that a low-dose, steroid replacement might be beneficial to critical illness.

Adrenocorticotropic Hormone↗

Plastic surgery of the face in Byzantium in the fourth century.

Oribasius was an eminent Byzantine physician who lived in the fourth century. His greatest contribution to medical history was his anthology of all important medical works of his time, entitled Synagogue Medicae. This complete medical encyclopedia of his era consisted of more than 70 volumes. A significant part of this work has been lost. What remains, however, allows us to glimpse the surprising richness and knowledge of ancient medicine. Chapters 25 and 26 of the original 42nd book of Oribasius are of specific interest to the plastic surgeon, because they deal with reconstruction of facial defects. Reconstructive procedures for defects in the eyebrows, forehead, cheeks, nose, and ears are described. Advancement flaps are suggested for the reconstruction, and recommendations are made about debridement, flap design, and thickness of flaps. It becomes obvious from these texts that Greek, Roman, and Byzantine surgeons had the knowledge and experience to perform several reconstructive procedures of the face and nose. This knowledge was passed to the Arabs and then to Western Europe in the 15th century and became part of the foundation for modern plastic surgery.

Byzantium↗

Pelvic floor reconstruction after major cancer surgery.

BACKGROUND: Many surgical techniques to keep the small intestine out of the pelvis after cancer surgery have been developed. METHODS: We used part of the ileum and its mesentery sutured around the linea terminalis in ten patients who underwent surgery for rectal or gynecologic carcinomas. RESULTS: All imaging studies of our patients on the tenth postoperative day confirmed the position of the bowel above the pelvis. Four of ten patients had radiation treatment postoperatively without any problems. CONCLUSION: Use of the ileum to reconstruct the pelvic floor seems to be a simple and efficacious technique to keep the pelvic area free. We believe this warrants further investigation in a larger number of patients.

Aged↗

Percutaneous drainage of intra-abdominal abscesses using large lumen tubes under computed tomographic control.

OBJECTIVE: To describe our experience of percutaneous drainage of intra-abdominal abscesses with large-bore catheters under computed tomographic control. DESIGN: Retrospective study. SETTING: Teaching hospital, Greece. SUBJECTS: 185 Patients treated for abdominal abscesses during the period 1989-94. INTERVENTIONS: Needle aspiration (n = 27), drainage through conventional pigtail catheters (n = 22), and drainage through large-bore (8-16F) Argyle drains (n = 136). MAIN OUTCOME MEASURES: Morbidity. RESULTS: The overall success rate was 166/185 (92%). Of the 136 patients for whom the large-bore drains were used, 9 (7%) developed major complications (bowel fistula, n = 5; and pneumothorax and haemorrhage, n = 2 each) and 10 (7%) developed minor complications (obstruction of the tube, n = 4; dislocation of the tube, n = 3; bleeding from the wound, n = 2; and haematoma of the liver, n = 1). There were no deaths. CONCLUSION: Large-bore Argyle drains are efficient and safe for the percutaneous drainage of certain types of abdominal abscesses.

Abdominal Abscess↗