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Biomedical subjects

E C Tsimoyiannis

Publications and source records attributed to E C Tsimoyiannis.

At least 19 recordsLinked to original sources
PubMed2006

Intrathoracic cancer of the splenic flexure.

Blunt traumatic rupture of the diaphragm is a well known but uncommon event of thoracoabdominal traumatic injuries. It occurs in 1-5% of polytrauma patients and requires a high degree of suspicion for a rapid diagnosis. The frequency of delayed diagnosis is difficult to be estimated and up to 30% of blunt diaphragmatic ruptures present late. A case of herniated splenic colic flexure through a defect in the left hemidiaphragm and the subsequent development of colon cancer in this area are presented. We emphasize the importance of making a prompt diagnosis in order to avoid further morbidity and mortality in this rare clinical entity.

Accidents, Traffic↗
PubMed2005

Uric acid and oxidative stress.

Uric acid is the final product of purine metabolism in humans. The final two reactions of its production catalyzing the conversion of hypoxanthine to xanthine and the latter to uric acid are catalysed by the enzyme xanthine oxidoreductase, which may attain two inter-convertible forms, namely xanthine dehydrogenase or xanthine oxidase. The latter uses molecular oxygen as electron acceptor and generates superoxide anion and other reactive oxygen products. The role of uric acid in conditions associated with oxidative stress is not entirely clear. Evidence mainly based on epidemiological studies suggests that increased serum levels of uric acid are a risk factor for cardiovascular disease where oxidative stress plays an important pathophysiological role. Also, allopurinol, a xanthine oxidoreductase inhibitor that lowers serum levels of uric acid exerts protective effects in situations associated with oxidative stress (e.g. ischaemia-reperfusion injury, cardiovascular disease). However, there is increasing experimental and clinical evidence showing that uric acid has an important role in vivo as an antioxidant. This review presents the current evidence regarding the antioxidant role of uric acid and suggests that it has an important role as an oxidative stress marker and a potential therapeutic role as an antioxidant. Further well designed clinical studies are needed to clarify the potential use of uric acid (or uric acid precursors) in diseases associated with oxidative stress.

Animals↗
PubMed2001

Laparoscopic surgery-induced changes in oxidative stress markers in human plasma.

BACKGROUND: The induction of the pneumoperitoneum increases intraabdominal pressure (IAP), causing splanchnic ischemia, whereas its deflation normalizes IAP and splanchnic blood flow. This procedure appears to represent an ischemia-reperfusion model in humans. METHODS: Thirty laparoscopic cholecystectomies (LC) were performed in 30 patients with a mean age of 54.6 +/- 15.6 years. A group of 20 patients mean age, 57.3 +/- 9.65 who underwent open cholecystectomy (OC) was also studied. Vein plasma levels of thiobarbituric acid-reactive substances (TBARS), a marker of free radical production; plasma total antioxidant status (TAS); and uric acid (UA) levels were measured preoperatively, 5 min after deflation of the pneumoperitoneum or at the end of operation, and 24 h postoperatively. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBL) levels were measured preoperatively and 24 h after the operation. RESULTS: In the LC group, significant elevations in the concentration of TBARS were observed in the early postoperative measurements in comparison with the preoperative measurements. TAS and UA levels were decreased significantly 24 h postoperatively compared to preoperative levels. The postoperative levels of AST, ALT, and TBL increased significantly in comparison with the preoperative levels. In the OC group, no alterations in the concentration of TBARS were observed in the postoperative period. The other parameters had changes similar to those recorded for the LC group. CONCLUSIONS: Free radical-induced lipid peroxidation associated with a decrease in plasma antioxidant capacity and UA levels as well as altered hepatic function is observed after deflation of the pneumoperitoneum. These results suggest that free radicals are generated at the end of a laparoscopic procedure, possibly as a result of an ischemia-reperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum.

Alanine Transaminase↗
PubMed2001

Lipid peroxidation and the use of emulsified propofol in laparoscopic surgery.

BACKGROUND: Free radical-induced lipid peroxidation associated with a decrease of antioxidant capacity in plasma is observed after the deflation of the pneumoperitoneum in laparoscopic surgery. In this study, we evaluated the effect of the continuous administration of lipid peroxidation derivatives on emulsified propofol. METHODS: Two groups of 20 patients each who underwent laparoscopic surgery were studied prospectively. Maintenance of anesthesia was achieved with 66% nitrous oxide and either isoflurane or continuous propofol administration. The level of thiobarbituric acid-reactive substances (TBARS) in the plasma was determined as a measure of free radicals before and after surgery. RESULTS: Ten patients in the propofol group had reduced TBARS, as compared to only one in the isoflurane group (p = 0.003). There was a statistically significant difference in age between the patients with reduced TBARS and those without reduced TBARS (p = 0.009) in the propofol group. CONCLUSIONS: Anesthesia with continuous propofol infusion in laparoscopic surgery has a significant scavenging action on the formation of free radicals and exerts its greatest antioxidant effect in patients >/=48 years of age.

Anesthesia, Inhalation↗
PubMed2001

Seroma in laparoscopic ventral hernioplasty.

SUMMARY: Seroma is a frequent complication of laparoscopic or open repair of ventral hernias using expanded polytetrafluoroethylene mesh. Aspiration of this seroma has the risk of introducing bacteria, resulting in infection and the recurrence of the hernia. Between May 1996 and December 2000, 51 patents who underwent 53 laparoscopic ventral hernioplasties (44 incisional, 5 large epigastric, and 4 large umbilical) were randomized to participate in a trial comparing the intraperitoneal onlay mesh repair with or without cauterization of the hernia sac. Group A (26 patients; 28 hernias) patients were operated on by using an expanded polytetrafluoroethylene Dual Mesh patch (Gore and Associates, Flagstaff, AZ, U.S.A.) inserted intraperitoneally and secured by full-thickness stitches and endoscopic clips to cover the hernia defect, while the sac was left intact. Group B (25 patients, 25 hernias) patients were operated on according to the same technique as those in group A, but the hernia sac was cauterized by monopolar cautery (5 cases) or harmonic scalpel (20 cases). After surgery, clinical examination and computed tomography scans were used to confirm or test the existence of seroma and recurrence. In group A, four clinically evident seromas were found. Two of them were resolved with no intervention. In the remaining two cases, multiple aspirations were needed for 4 and 7 months, respectively, but 2 and 3 months, respectively, after resolution of the seroma, a recurrence of the hernia was observed. There was one more recurrence without seroma and three with subclinical seromas (only observed on computed tomography scans). In group B, subclinical seroma (only observed in computed tomography scan) resolved in a few days, and one recurrence without seroma was observed. Although only a small number of patients were studied, our findings suggest that the cauterization of the hernia sac prevents seromas and reduces recurrences in laparoscopic repair of ventral hernias.

Aged↗
PubMed2000

Laparoscopic placement of the Tenckhoff catheter for peritoneal dialysis.

Continuous ambulatory peritoneal dialysis catheters can be inserted by open laparotomy as well as by laparoscopy. A prospective randomized study was scheduled to investigate the results of the laparoscopic versus open laparotomy technique for placement of continuous ambulatory peritoneal dialysis catheters. Fifty patients were enrolled and randomly allocated into two groups of 25 patients each. Group A underwent continuous ambulatory peritoneal dialysis catheter placement via the open laparotomy technique. In 22 patients, catheters were inserted via midline incision, and in 3 patients with histories of previous catheterization, a paramedian incision was used. Continuous ambulatory peritoneal dialysis was started 24 to 48 hours later. Group B underwent laparoscopic placement of the catheter with fixation into the pelvis and suture closure of the port wounds. In 21 patients, this catheter placement was the first such placement, and in 4 patients, a previous catheter had been inserted by the open technique and removed for dysfunction. Continuous ambulatory peritoneal dialysis was started at the end of the procedure. The mean operative time was 22 minutes in group A and 29 minutes in group B (P < 0.001). Fluid leakage was observed in eight patients in group A, but in no patients in group B (P < 0.005). Peritonitis occurred in five patients in group A and in three patients in group B (P > 0.1). Tip migration occurred in five patients in group A and no patients in group B (P < 0.005). In group B, two patients underwent a simultaneous cholecystectomy and one underwent incisional hernia repair. Laparoscopic placement of a Tenckhoff catheter leads to better function than does the open procedure; it allows immediate start of dialysis without fluid leakage and permits simultaneous performance of other laparoscopic procedures.

Aged↗
PubMed1998

Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy.

After laparoscopic surgery carbon dioxide remains within the peritoneal cavity for a few days, commonly causing pain. This prospective randomized study was performed to determine the efficacy of intraperitoneal infusion of normal saline on postoperative pain after laparoscopic cholecystectomy. Altogether 300 patients were randomly assigned to one of five groups of 60 patients each. Group A: control group, no peritoneal infusion, no subhepatic drain. Group B: no peritoneal infusion but a subhepatic closed brain was left for 24 hours. Group C: normal saline 25 to 30 ml/kg body weight at a temperature of 37 degrees C was infused under the right hemidiaphragm and left in the peritoneal cavity. Group D: normal saline in a room temperature was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated. Group E: normal saline was infused and suctioned as in group D, but a subhepatic closed drain was left for 24 hours. Postoperatively, analgesic medication usage, nausea, vomiting, and pain scores were determined at 2, 6, 12, 24, 48, and 72 hours (during hospitalization and at home). Postoperative pain was reduced significantly (p < 0.001) in the patients of groups C, D, and E versus controls, whereas no difference was observed between groups A and B. Among groups C < D and E, group E (p < 0.01) had the best results followed by group D and then group C. Intraperitoneal normal saline offered a detectable benefit to patients undergoing laparoscopic cholecystectomy. The beneficial effect was better when the fluid was suctioned after deflation of the pneumoperitoneum and even better when a subhepatic closed drain continued fluid suction during the first postoperative hours.

Cholecystectomy, Laparoscopic↗
PubMed1998

Laparoscopic intraperitoneal onlay mesh repair of incisional hernia.

Improvements in laparoscopic techniques and equipment have engendered many new intraabdominal procedures. Laparoscopic hernioplasty was used in 11 patients with 12 incisional abdominal hernias. All repairs were made with an intraperitoneal onlay patch of expanded polytef Gore-Tex DualMesh Biomaterial. The patch was secured by whole-thickness sutures, tied subcutaneously through stab holes, and staples between the sutures to cover the hernia defect without excision of the hernia sac. There were three postoperative complications: one seroma, one hematoma, and one infection. These complications successfully healed without reoperation. No recurrence was observed during a follow-up of 8-21 months (average 15 months). It is concluded that laparoscopic incisional hernioplasty using the new Gore-Tex DualMesh Biomaterial, which is securely sutured and stapled on the abdominal wall, is a promising minimally invasive procedure. Continued follow-up is necessary to determine the long-term results.

Adult↗
PubMed1998

Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy.

After laparoscopic cholecystectomy, CO2 remains within the peritoneal cavity, commonly causing pain. This prospective randomized study was performed to determine the efficacy of intraperitoneal normal saline and bupivacaine infusion on postoperative pain after laparoscopic cholecystectomy. Three hundred patients were randomly assigned to one of six groups of 50 patients each. Group A patients served as controls. In group B patients, normal saline was infused under the right hemidiaphragm and suctioned after the pneumoperitoneum was deflated. After suction, a subhepatic closed drain was left for 24 h. In group C patients, bupivacaine 1.5 mg/kg in solution 2.5 mg/ml, minus 15 ml of this solution, which was infiltrated in the trocar wounds, was infused under the right hemidiaphragm at the end of the cholecystectomy. In group D patients, bupivacaine was given as in group C, but a subhepatic drain was left for 24 h. In group E patients, normal saline was used as in group B plus bupivacaine as in group C. Group F patients were treated as in group E, but a subhepatic drain was left for 24 h. In all groups, 15 ml of a 2.5 mg/ml bupivacaine solution was infiltrated in the trocar wounds. Postoperatively, analgesic medication usage, nausea, vomiting, and pain scores were recorded at 2, 6, 12, 24, 36, 48, and 72 h. Postoperative pain was reduced significantly in the patients of the treatment groups vs. the controls. Between treatment groups, patients in groups B, E, and F had the best results, while those in groups C and D had significantly greater pain than those in groups B, E, and F. It is concluded that postoperative pain after laparoscopic cholecystectomy can be significantly reduced by intraperitoneal normal saline infusion subdiaphragmatically and after its postdeflation suction, bupivacaine infusion in the same area, or without bupivacaine in case a subhepatic drainage has been needed.

Adult↗
PubMed1998

Laparoscopic cholecystectomy using ultrasonically activated coagulating shears.

Ultrasonic energy has recently been used for surgical cutting and coagulating. A prospective randomized study was undertaken to determine the effectiveness of ultrasonic energy versus monopolar electrosurgery in human laparoscopic cholecystectomy. Two hundred patients were enrolled and randomized into two groups of 100 patients each. Group A patients underwent laparoscopic cholecystectomy with monopolar electrocautery. Group B patients underwent laparoscopic cholecystectomy with ultrasonically activated shears. In 18 cases of this group, the cystic artery was coagulated and cut without clips. Subhepatic closed drainage was left for 24 h in patients who were candidates for oozing of blood or leakage of bile. The median operating time was 45 min in group A and 37 min in group B. Subhepatic drainage was left in 37 patients of group A and 26 of group B. The median blood loss was 14 ml in group A and 2 ml in group B, while 3 patients of group A and none of group B had bile leakage from the bed of the gallbladder for 1, 1, and 6 days, respectively. Postoperative ultrasound examination showed a minor subhepatic fluid collection in 5 patients of group A and in 1 patient of group B. All these collections were treated without drainage. The length of hospital stay was 1.9 +/- 0.5 days in group A and 1.4 +/- 0.2 days in group B. Postoperative pain scores, nausea, and vomiting were equivalent in both groups. It is concluded that ultrasonically activated coagulating shears are safer, easier to use, faster, and less prone to intraoperative complications and postoperative morbidity than monopolar electrocautery in laparoscopic cholecystectomy.

Adult↗
PubMed1996

Low-molecular-weight heparins and Daflon for prevention of postoperative thromboembolism.

The efficacy of low-molecular-weight heparins (LMWH) alone versus a combination of Daflon 500 mg with LMWH in preventing postoperative symptomatic thromboembolism was investigated. A total of 1372 patients aged 40 years or older undergoing major abdominal, pelvic, or abdominal wall surgery were randomized into four groups. Group A (n = 591) received enoxoparin 20 mg or fraxiparin 0.3 ml. Group B (n = 595) received the regimens of group A plus Daflon 500 mg. Group C (n = 93) received enoxoparin 40 mg or fraxiparin 0.6 ml. Group D (n = 93) received the regimens of group C plus Daflon 500 mg. Each LMWH was given subcutaneously once a day during the hospitalization and continued in groups C and D for 15 days after discharge (high risk patients). Daflon 500 mg was given as two tablets every 8 hours during the day before surgery, two tablets 6 hours before surgery, and two tablets once a day on postoperative days 4 to 15. Daily clinical examination was performed; and phlebography or perfusion lung scanning (or both) were used in symptomatic patients to confirm deep vein thrombosis (DVT) or pulmonary embolism (PE). The wound was examined on a daily basis for hematomas. The diagnosis of PE was established in two patients of group A and in three patients of group C; symptomatic DVT was established in one patient in group A and three patients of group C. Neither DVT nor PE were established in Daflon 500 mg groups. These data suggest that the combination of Daflon 500 mg and LMWH is more effective than LMWH alone for preventing symptomatic thromboembolism.

Adult↗
PubMed1994

Cholelithiasis during pregnancy and lactation. Prospective study.

OBJECTIVE: To assess the incidence of formation of gallstones during pregnancy and lactation, the time when gallstones first appear, and any changes in predisposing factors. DESIGN: Prospective study. SETTING: District hospital, Greece. SUBJECTS: 669 pregnant women seen between 1988 and 1991. MAIN OUTCOME MEASURES: Body mass index (kg/m2); real time ultrasonography; and measurements of serum concentrations of bilirubin, total cholesterol, low density lipoprotein cholesterol, and triglycerides, and of activities of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and amylase. All measurements were made at the beginning of pregnancy; at the third, sixth and ninth months; and 7 days and 6 months after delivery. RESULTS: 6 women (1%) mean age 26 years, had pre-existent gallstones and 14 further women (2%) mean age 27 years, developed gallstones; 13 were discovered during pregnancy (8 during the second trimester, and 5 during the third) and one during lactation. Women who had 3 or more pregnancies (6/110, 5%) were significantly more likely to develop gallstones than those who had not been pregnant before (3/304, 1%, p = 0.01). Gallbladder volume more than doubled during pregnancy from a mean (SD) of 12 (4) to 26 (4) ml. Total cholesterol, low density lipoprotein cholesterol and triglyceride concentrations, and alkaline phosphatase activity increased gradually, and reverted to the value found at the beginning of pregnancy immediately after delivery. CONCLUSIONS: The risk of developing gallstones increased with the number of pregnancies, and most of the stones developed during the second or third trimester.

Adult↗
PubMed1994

Cholecystectomy and hernioplasty during the same laparoscopic procedure.

Cholelithiasis and inguinal or femoral hernia usually coexist in the same patient. The simultaneous laparoscopic approach to these diseases benefits the patients, who avoid two separate admissions to the hospital, two operations, and twice the cost, recuperation, and potential morbidity and mortality. The authors describe a technique that facilitates cholecystectomy and hernioplasty during the same laparoscopic approach, thus avoiding the use of two separate procedures. The results of this procedure in the first six patients were excellent.

Abdominal Muscles↗
PubMed1993

Trimetazidine for prevention of hepatic injury induced by ischaemia and reperfusion in rats.

OBJECTIVE: To assess the effect of trimetazidine (an anti-anginal drug that acts as a scavenger of oxygen free radicals) in the protection of hepatocytes after a 90 minute period of warm ischaemia followed by reperfusion in rats. DESIGN: Prospective study. MATERIAL: 80 Wistar rats. INTERVENTIONS: 20 Rats were given a single dose of trimetazidine 2.5 mg/kg intravenously 30 minutes before the induction of ischaemia; 20 received the same dose intraperitoneally twice a day for five days before the experiment and one dose intravenously 30 minutes before; 20 were given a single dose of 2.5 mg/kg intravenously after reperfusion had been started; and 20 acted as controls. All rats underwent liver biopsy through a laparotomy incision on postoperative days 2, 7, and 21, and the activities of liver enzymes in their blood were measured before induction of ischaemia and two, seven, 14, and 21 days afterwards. OUTCOME MEASURES: Histological changes and serum enzyme activities. RESULTS: The amount of centrilobular necrosis of hepatocytes, and the activity of hepatic enzymes were greatest on day 2, as was the reduction in superoxide dismutase activity in the erythrocytes. A single dose of trimetazidine, whether given before or after the ischaemic episode, gave significant protection to hepatocytes, but pretreatment for five days was even more effective. CONCLUSION: Trimetazidine protected rats' livers from injury after a period of warm ischaemia and reperfusion.

Animals↗
PubMed1992

Water as contrast medium for computed tomography study of colonic wall lesions.

A tap water enema combined with intravenous iodine contrast medium was used for computed tomographic (CT) study of the entire clean colon in 35 patients. Thirty of them showed a high suspicion of rectal, colon, or cecal pathology at either clinical examination, barium enema study, or endoscopy. The remaining five patients were examined for suspected local recurrence of carcinoma. This CT technique detected the wall abnormality in all but one case with two small adenomatous polyps. This procedure, which is simple, inexpensive, and has a good acceptance and tolerance, can accurately detect mural wall abnormalities.

Colonic Neoplasms↗