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Biomedical subjects

E Bastounis

Publications and source records attributed to E Bastounis.

At least 37 records · Page 2Linked to original sources
PubMed2001

Study comparing sutures and nonpenetrating titanium clips for arteriotomy closure after embolectomy.

BACKGROUND: The vascular closure staple (VCS) clip applier system is an alternative to suture for closing arteriotomies and performing vascular anastomoses. This study was designed to evaluate the possible advantages of its use in closing arteriotomies after embolectomy. METHODS: In this study, 26 patients with upper or lower extremity embolism underwent embolectomy, and the arteriotomy was closed using either VCS clips (group A) or sutures (group B). RESULTS: The time required for arteriotomy closure with clips (11.2 +/- 2.7s) was considerably shorter than the time required with sutures (241.2 +/- 48.7s; p < 0.0001), resulting also in shorter clamp times (380.8 +/- 127.3s vs 612.7 +/- 112.6 s; p < 0.0001). No hemodynamically significant stenoses or pseudoaneurysms were detected at the arteriotomy sites in any of the patients up to 1 year after embolectomy. CONCLUSIONS: The VCS clip applier system, a quick and easy method for closing arteriotomies, is as safe as sutures in terms of narrowing of the artery and formation of pseudoaneurysm.

Aged↗
PubMed2001

Current practice--routine use of shunting in carotid endarterectomy. Cost reduction and surgical training.

BACKGROUND: Sophisticated methods of determining cerebral blood flow have reduced the use of shunting in carotid endarterectomy in 6-25% of cases. However teaching university hospitals still have to provide their young vascular surgeons with experience in the shunting procedure. Since complications of shunting have been related to the surgeon's experience in the technique, our study aimed to evaluate a policy of the routine use of shunting in carotid endarterectomy by vascular surgeons in training. In addition to concluding how this policy would affect the optimum outcome of our patients. The probable reduction of hospital charges was also evaluated. METHODS: A prospective audit of the results of 423 consecutive carotid endarterectomies performed by a senior vascular surgeon (the first 97 cases) and a vascular surgeon in training under the supervision of a senior vascular surgeon (326 cases), with routine use of an indwelling intraluminal shunt, in a university hospital in Athens. RESULTS: During the study period, 337 patients admitted to our department were managed surgically independently of any demanding surgery due to the anatomy and the extension of internal carotid artery disease. The perioperative stroke/death rate at 30 days was 0.47%, but the stroke rate alone was 0%. Minor complications amounted to 5.4%, with an increased but not significant difference in patients presenting contralateral internal carotid occlusion. There was no difference in complication rates when a young surgeon performed the shunting procedure compared with the experienced senior surgeon's results, but this was achieved after training in the method in the first 97 cases. The reduction of the total cost was related to avoidance of cost of the devices necessary for determination of the cerebral circulation during carotid clamping and the cost of specially trained personnel. Our policy resulted in only eight patients having to be treated in the intensive care unit for a total of 13 days. CONCLUSIONS: Experience in a large number of shunting procedures are required for a young vascular surgeon's training, in order to achieve optimum results. This can be done in teaching hospitals by using the method more frequently than required. Moreover in the contest of continuing changes in the practice of carotid endarterectomy and the economic restrictions on health expenditure, the routine use of shunting resulted in cost saving without jeopardizing the patients' outcome.

Aged↗
PubMed2000

Serum Lp(a) lipoprotein levels in patients with atherosclerotic occlusive disease of the lower extremities.

OBJECTIVE: To evaluate the association between Lp(a) lipoprotein levels, other serum lipids and the presence of lower limb atherosclerotic occlusive disease. MATERIALS AND METHODS: Angiographic findings in 36 patients were related to serum Lp(a). Total cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol and Lp(a) levels were compared with those of 73 age- and sex-matched healthy controls. RESULTS: Atheromatous lesions were localised in the femoropopliteal ( approximately 60%) and aortoiliac ( approximately 40%) segments. The number of stenosed arteries was > or =2 and the range of stenosis severity was between 40% and 100%. There was a significant increase in serum Lp(a) (p= 0.000001) and a decrease in serum HDL (p= 0.000009) levels in patients compared to controls. No difference was observed in total cholesterol, LDL-cholesterol or triglyceride. However, the ratio of total cholesterol/HDL-cholesterol was significantly higher (p= 0.005) in patients. CONCLUSION: A dyslipidaemic serum profile, characterised by increased Lp(a) levels and decreased HDL-cholesterol levels, is associated with atherosclerotic occlusive disease of the lower extremities.

Aged↗
PubMed2000

General surgery in haemophiliac patients.

With improvements in medical technology, more and larger surgical procedures are performed in haemophiliac patients, but rarely reported in the surgical literature. A retrospective study from a 10 year period from one referral centre identified a total of 68 operations performed in haemophiliac patients. The levels of the defective factors were carefully monitored preoperatively and postoperatively, and replaced according to a standard formula. Special caution was taken to avoid any postoperative medication or procedures that could provoke haemorrhagic complications.Two patients suffered postoperative bleeding complications that were managed conservatively. Inhibitory factors were detected preoperatively in one case, and postoperatively in another, and were managed with aggressive replacement therapy. There was no mortality, and the overall morbidity rate was 6%. With adequate preoperative and postoperative monitoring of the clotting factors, meticulous haemostasis during surgery, careful postoperative nursing, and timely replacement therapy, haemophiliac patients can be operated with good results. Postoperative bleeding complications are rare, and usually amenable to conservative management.

Adolescent↗
PubMed2000

Malignant melanoma of the anorectal area. Report of two cases.

BACKGROUND/AIMS: Primary anorectal melanoma is a very rare malignant tumor with no more than 300 cases reported in the literature. METHODS: Two cases of anorectal melanoma are reported herein. RESULTS: Both patients, aged 44 and 74 years, presented at the outpatient department with anal bleeding, one after being treated for 3 months with antihemorrhoidal drugs. The diagnosis was established with proctoscopy and biopsy, and a palliative abdominoperineal resection in the presence of lymph node metastases was performed followed by chemotherapy with vindesine. Although the procedures were not curative, both patients had an uneventful postoperative recovery, and lived 4 years and 21 months, respectively, without bleeding problems albeit with the inconvenience of a colostomy. CONCLUSIONS: For the time being there is no convincing proof of the value of either types of proposed surgical management. We agree with those who believe that abdominal perineal resection has an advantage regarding the prognosis and quality of life.

Adult↗
PubMed2000

Pathological changes of hepatic artery and portal vein, after allyl-alcohol and carbon tetrachloride administration. An experimental study.

BACKGROUND: Allyl-alcohol (AA) and carbon tetrachloride (CC14) are known to cause peritoneal and pericentral liver necrosis, respectively. This study investigates pathological changes of hepatic artery and portal vein after simultaneous administration of AA and CC14 in rats. METHODS: The study comprised 130 male Wistar rats divided randomly into 2 groups: I (n=10) sham and II (n=120) AA injection (intraperitoneally: 0.62 mmol/kg) and rhinogastric administration of CC14 (0.66 ml/kg, 1:1 volume dilution in corn oil). After injection was completed, animals of group II were assigned in 12 categories and sacrificed 2, 4, 6, 12, 18, 24, 33, 48, 57, 81, and 153 hrs after. Tissue was obtained from the left anterior lobe and the hilum of the liver, and histological examination included H&E, silver methenamine and van Giesson stains. RESULTS: Liver sections from group II (AA+CC14) demonstrated periportal together with pericentral necrosis; the peak was 57 hrs after injection. In all 120 cases, H&E stain showed evidence of regeneration originated from zone 2, extending to zone 1 and occasionally to zone 3, and accomplished mainly by non-necrotic cell proliferation. Sections from the liver hilum showed thrombosis of the portal vein, whereas the hepatic artery and its branches developed a variety of changes. Initially (2, 4 hrs), endothelial hypertrophy was observed which was followed by focal fibrinoid necrosis of the arterial wall (6 hrs). Later on (9-153 hrs) the following findings were present: hyperplasia and non-isometric cytoplasmic vacuolisation of media, disruption of the elastic lamina, aggregation of foam cells and macrophages in intima, media, and focally in adventitia of hepatic artery; and lymphocytic inflammation of intimal and periadventitial area. In 2 cases (153 hrs) hepatic artery thrombosis was present. CONCLUSIONS: Additionally to liver parenchymal changes, simultaneous administration of allyl-alcohol and carbon tetrachloride in rats results to vascular changes mainly in the hepatic artery and its branches. During liver parenchymal regeneration, the hepatic artery and its branches develop microscopic features that morphologically resemble those of atherosclerosis. These changes may result in hepatic artery thrombosis and or obstruction.

Animals↗
PubMed1999

PTFE-vein composite grafts for critical limb ischaemia: a valuable alternative to all-autogenous infrageniculate reconstructions.

OBJECTIVES: to analyse the long-term results of primary composite bypass grafts comparing them to PTFE and vein grafts. DESIGN: a retrospective observational study. MATERIALS AND METHODS: between 1980 and 1996, 568 primary infrageniculate bypass procedures were performed; a saphenous-vein graft was used in 428 procedures, a PTFE graft in 44 and a composite PTFE-saphenous-vein graft in 96. Thirty-six composite grafts were below the knee and the remaining 60 extended more distally. Twenty-one bypass grafts from the latter group were sequential. Mean follow-up was 45.6 months. Five-year primary and secondary patency and limb salvage rates were compared by life-table analysis. RESULTS: cumulative 5-year primary patency for composite grafts was 58% and for saphenous-vein grafts 74%, while secondary patency rate was 75% and 82%, respectively (p <0.05). The 5-year limb salvage rate was 80% for composite grafts and 88% for saphenous-vein grafts (p >0.05). The primary and secondary patency and limb salvage rate for PTFE grafts was 24%, 31% and 40%, respectively. CONCLUSION: Composite grafts of PTFE and saphenous vein are significantly superior to PTFE graft alone and should be used in patients who lack sufficient length of saphenous vein.

Aged↗
PubMed1999

Surgical treatment of carotid body tumours.

OBJECTIVE: To evaluate our results of the treatment of patients with carotid body tumours. DESIGN: Retrospective study. SETTING: University hospital, Greece. SUBJECTS: 17 patients operated on for a carotid body tumour during the past 20 years. MAIN OUTCOME MEASURES: Hospital mortality and morbidity, long-term outcome. RESULTS: 3 patients had temporary cranial nerve lesions postoperatively, all of which resolved within three months. One patient developed a severe stroke and died seven days postoperatively. During follow-up that ranged from 7 months to 20 years, two patients died of unrelated causes. 5 patients were lost to follow up, and the remaining 10 were doing well with no signs of recurrence at the time of writing. CONCLUSION: Excision of a carotid body tumour is recommended at the time of initial diagnosis in good-risk patients to avoid the difficulty of subsequent excision of an enlarging and highly vascular tumour with possible encasement of the carotid artery.

Adult↗
PubMed1999

Chest wall ectopic synovial bursa cyst.

We report an unusual case of chest wall tumor in a 27-year-old patient. A complete resection was accomplished, and the patient had an excellent postoperative course. Histologically, the mass was confirmed to be an ectopic synovial bursa cyst. Although rare, synovial cysts should be considered in any case of a fluctuating chest wall mass. We also discuss the etiology and diagnostic approach of cystic masses of the chest wall.

Adult↗
PubMed1999

Polypoid hamartoma of Brunner's gland of the duodenum.

BACKGROUND/AIMS: Brunner's gland adenoma is an extremely rare but important entity. Controversy exists over its etiology and pathogenesis, but the present view is that it is a duodenal hamartoma with a predominance of Brunner's gland elements. METHODS: A case of a 76-year-old woman with a reddish pedunculated polyp prolapsing between the bulb and the second part of the duodenum seen at endoscopy and removed surgically through a longitudinal duodenotomy is presented. RESULTS: The cut surface of the tumor had a grayish color, revealing multiple cystic spaces which on microscopic examination proved to be enlarged Brunner's glands. The hyperplastic glands formed lobules which were surrounded by bundles of fibromuscular and connective tissue. In the adjacent duodenum, large numbers of lobules of well-differentiated Brunner's glands with mucus-secreting epithelial cells were seen. CONCLUSION: The reported case supports the theory that Brunner's gland adenomas are duodenal hamartomas with a predominance of Brunner's gland elements and further shows that a continuity exists in Brunner's glands of the tumor and those of the adjacent duodenum.

Aged↗
PubMed1999

Tuberculoma of the spleen: a rare but important clinical entity.

Tuberculoma of the spleen has been an extremely rare entity during the last decades in the Western world. We describe a case in a young, HIV-negative woman who was evaluated for fever of unknown origin. The workup was initially negative, and she was treated successfully with steroids and nonsteroidal anti-inflammatory analgesics. Recurrence of the fever and an abnormal CT of the abdomen lead to an exploratory laparotomy, which revealed a subcapsular caseous material containing splenic abscess. The very few cases reported in the literature, and the increasing incidence of extrapulmonary tuberculosis due to the alarming numbers of immunodeficient patients that a surgeon may encounter are also discussed.

Adult↗
PubMed1998

Revascularization of the limbs using vein grafts after vascular injuries.

We report on 32 patients with vascular injury of a limb undergoing a total of 41 revascularization procedures with interposition vein grafts. A combined arterial and venous injury was present in nine cases, an isolated venous injury in four, and an isolated arterial injury in 19 cases. Eighteen per cent of patients with arterial injuries had normal distal pulses on initial examination. Preoperative arteriography was performed in 12 cases, and intraoperative arteriography in four. All venous injuries were diagnosed at operation. In most cases, the contralateral greater saphenous vein was used for grafting. Four patients had postoperative thrombosis after arterial reconstruction resulting in below knee amputation in two cases. Two patients suffered from postoperative swelling caused by venous insufficiency, one after ligation of an injured axillary vein, and the other one following venous thrombosis of a superficial femoral vein repair. It is concluded that revascularization of arterial and venous injuries of the extremities with interposition vein grafts is successful in most cases resulting in low amputation rates, and should be attempted in all major vascular injuries in viable limbs.

Adolescent↗
PubMed1998

Surgery for renal artery aneurysms: a combined series of two large centers.

OBJECTIVE: To review the clinical features and results of surgical treatment of renal artery aneurysms from two large centers. PATIENTS AND METHODS: A retrospective analysis of 21 hypertensive patients with renal artery aneurysms operated in two centers during a 24-year period was performed. RESULTS: The presenting symptom was subcostal or flank pain in 8 (38%) and hematuria in 5 (24%) cases. A ring-like calcification was seen on plain X-ray in 6 (29%) cases. All patients were evaluated with renal angiography showing a saccular aneurysm in 13 cases (62%), fusiform in 5 (24%) and dissecting in 3 (14%) cases. All saccular aneurysms were treated with resection followed by reconstruction with vein patch in 10 cases, and with and end-to-end anastomosis in 3 cases. All fusiform and dissecting aneurysms were managed with resection and reconstruction using aortorenal bypass. There was no hospital mortality or significant morbidity. During a follow-up ranging from 6 months to 23 years, there was definite cure of hypertension in 14 (67%) patients and improvement of blood pressure levels in 4 (19%) patients. Three patients continued to be hypertensive. CONCLUSION: Surgery for renal artery aneurysms can be accomplished with good results and should be considered for patients with aneurysms greater than 2 cm, for aneurysms causing renovascular hypertension, significant stenosis, flank pain, or hematuria, for dissecting, expanding and thrombotic aneurysms, and in women with a potential for pregnancy. However, all aneurysms cannot and should not be treated surgically.

Abdominal Pain↗
PubMed1997

Benign retroperitoneal neural sheath tumors in patients without von Recklinghausen's disease.

Benign retroperitoneal neural sheath tumors in patients without von Recklinghausen's disease are quite rare and usually presented as isolated case reports. There are two types of benign neural sheath neoplasms: schwannoma and neurofibroma. Confusion exists in the nomenclature of these tumors due to the disagreement upon their cell of origin. In a collective report from two institutions, three cases with benign retroperitoneal neural sheath tumors are presented, and the histological features, diagnostic and therapeutic options are discussed.

Aged↗
PubMed1997

The role of profunda femoris revascularization in aortofemoral surgery. An analysis of factors affecting graft patency.

BACKGROUND: To determine the long-term results of aortofemoral grafts using the profunda femoris artery as an outflow vessel and to determine the factors affecting the outcome of these procedures. DESIGN: Prospective study. METHODS: From 1980 to 1993, 224 profundoplasties were performed as an adjunctive outflow procedure of aortofemoral grafts in 180 patients. There were 167 men and 13 women with a mean age of 63.7 years. Severe claudication was the indication for operation in 147 limbs (65.6%), and critical ischemia in 77 (34.4%). Good runoff was present in 159 limbs (71%), while poor run-off in 65 (29%). Profundoplasty was extended distally in 67 cases (29.9%), while in the remaining 157 (70.1%) it was limited to the proximal portion of the artery. Arterial and venous patches were used alternatively for the profundoplasty. RESULTS: The 30-day mortality was 1.6% and the 5-year and 9-year survival rate was 69.7% and 49.1% respectively. Primary graft patency was 87.2% in 5 years and 78.5% in 9 years, while secondary graft patency was 90.1% in 5 years and 81.4% in 9 years. Limb salvage rate was 92.7% in 5 years and 87.6% in 9 years. There were four factors which were predictive of inferior longterm results namely; critical ischemia, poor run-off, extended profundoplasty and vein patch used for the profundoplasty. CONCLUSIONS: Angioplasty of the profunda femoris artery is a durable outflow procedure for aortofemoral graft surgery, when the above mentioned risk factors are absent; however when they do exist, the use of arterial patch for profundoplasty may improve the prognosis.

Aorta, Abdominal↗