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E Degiannis

Publications and source records attributed to E Degiannis.

At least 19 recordsLinked to original sources
PubMed2002

Critical decisions in trauma of the thoracic aorta.

Trauma to the thoracic aorta is a significant injury with a high mortality. This mortality is partly due to the delayed recognition of the condition. The increase of motor vehicle accidents and the use of firearms worldwide has resulted in an increase of the incidence of trauma to the thoracic aorta. Certain new developments in diagnosis and management have resulted in traditional methods being questioned. This review analyses current literature and data which we attempt to evaluate.

Aorta, Thoracic↗
PubMed2001

Gunshot injuries of the extrahepatic biliary ducts.

OBJECTIVE: To assess our management of gunshot injuries of the extrahepatic biliary ducts. DESIGN: Retrospective study. SETTING: Urban teaching hospital, South Africa. SUBJECTS: 17 patients who were found to have gunshot injuries of the extrahepatic bile ducts, January 1993-June 1998. INTERVENTIONS: Packing and damage control, staged repair, or definitive repair. MAIN OUTCOME MEASURES: Morbidity and mortality: Three of the 17 died intraoperatively or postoperatively from causes unrelated to the biliary injury. Of the 14 survivors, 3 were managed initially with packing and damage control, 7 by staged repair, and 4 by definitive biliary repair. Eleven patients had a Roux-en-Y biliary jejunostomy, of whom 1 developed a late biliary stricture related to a postoperative anastomotic leak. End-to-end anastomosis of the bile duct was done for 2 patients and they both developed late biliary strictures. Ligation of the injured duct and cholecystojejunostomy was done for I patient. CONCLUSION: Roux-en-Y biliary-jejunal anastomosis is appropriate in the treatment of gunshot injuries of the extrahepatic biliary ducts as there is always a degree of tissue loss and some debridement is required, making it difficult to do a tension-free anastomosis.

Adult↗
PubMed2000

Non-operative treatment of abdominal gunshot injuries.

BACKGROUND: Non-operative treatment is a management option that challenges the traditional mandatory laparotomy for abdominal gunshot injuries. METHODS: All published relevant clinical reports were retrieved by searching through the Medline database and manually. The theoretical arguments in favour of non-operative management as well as the results of the reviewed reports are analysed and evaluated. RESULTS AND CONCLUSION: Patients with proven non-penetration of the abdominal cavity can be offered conservative treatment with a satisfactory outcome. Greater caution should be exercised in the presence of a documented visceral injury until the safety of this option has been established by further clinical trials.

Abdominal Injuries↗
PubMed2000

Duodenal injuries.

BACKGROUND: The worldwide increase in road traffic accidents and use of firearms has increased the incidence of duodenal trauma. METHODS: The English language literature on duodenal trauma over the period 1970-1999 was reviewed. RESULTS AND CONCLUSION: Upper gastrointestinal radiological studies and computed tomography may lead to the diagnosis of blunt duodenal trauma. Exploratory laparotomy remains the ultimate diagnostic test if a high suspicion of duodenal injury continues in the face of absent or equivocal radiographic signs. The majority of duodenal injuries may be managed by simple repair. More complicated injuries require more sophisticated techniques. High-risk duodenal injuries are followed by a high incidence of suture line dehiscence and they should be treated by duodenal diversion. Pancreaticoduodenectomy should be considered only if no alternative is available. 'Damage control' should precede definitive reconstruction.

Duodenum↗
PubMed2000

Transmediastinal gunshot injuries.

BACKGROUND: Transmediastinal gunshot injuries are a rarely reported injury. Until recently, assessment of the thoracic aorta by angiography preceded the investigation of the esophagus. This order has been recently debated. METHODS: There were 118 patients with potential transmediastinal injuries included in this retrospective study. Unstable patients who were unresponsive to resuscitation were taken to the operating room without previous investigation. Stable patients were routinely investigated initially for injury of the aorta and then for injury of the esophagus. RESULTS: There were 51 patients who underwent urgent thoracotomy/sternotomy. In 27, the hemorrhage was of mediastinal origin; 17 of these patients died of intraoperative bleeding. Eight of the patients had aortic injury, and only one of this group survived. There were 57 stable patients who were investigated initially for injury of the aorta by angiography. It was positive in only one patient who underwent an operation with good results. An investigation of the esophagus followed and revealed esophageal injury in 17 patients. All of them were treated operatively, 15 of them with satisfactory outcome. CONCLUSIONS: Angiography should at present precede esophageal investigations. There is a need for shortening the time between admission and operation. Other modalities that could expedite the investigation of the thoracic aorta and the esophagus should be prospectively evaluated in multi-center studies.

Adolescent↗
PubMed1999

Glutathione-linked enzymes in benign and malignant oesophageal tissue.

Oxyradicals are involved in multiple mutational events and can contribute to the conversion of healthy cells to cancer cells. Glutathione (GSH) and the GSH-replenishing enzymes keep the antioxidant status of normal cells at a level where they can avert oxyradical derived mutations. The aim of this study was to determine whether in cancer cells the GSH-replenishing, GSH antioxidant and GSH-depleting enzymes were not at appropriate levels and therefore not able to protect cancer cells adequately against oxyradical-induced mutations. Cancer of the oesophagus was chosen since it is the most common gastrointestinal malignancy in South African Blacks. Biopsies and blood from 31 patients with cancer of the oesophagus and 29 non-cancer patients were assessed for these enzymes. The mean activity of the antioxidant and depleting enzyme GSH-peroxidase was elevated significantly by twofold in the cancer tissue compared to normal tissue. However, the activity of the replenishing enzyme GSSG-reductase and the level of the depleting enzyme GSH-s-transferase P1-isoenzyme were significantly reduced by 23% and 33% respectively. As in a previous paper we found that GSH was depleted and gamma-glutamine transpeptidase was diminished in oesophageal cancer. There can be two reasons for GSH depletion. Firstly, elevated GSH-peroxidase will use more GSH in an attempt to cope with the excessive production of oxyradicals as revealed by elevated lipid peroxidation; this was, as shown by us before, elevated sixfold in oesophageal cancer. Secondly, if little replenishment of GSH occurred the level of GSH would become lower. This was confirmed by our findings that the activities of the replenishing enzymes were significantly diminished in oesophageal cancer tissue. Contrary to what was expected, the other depleting enzyme GSH-s-transferase P1 was not elevated in cancer tissue but was significantly lower. However, in the blood of the same patients it was significantly elevated. An explanation for this phenomenon is that, although the production of GST-P1 was enhanced in cancer, it did not show because it was rapidly extruded into the blood by an unknown mechanism operational only in cancer cells.

Esophageal Neoplasms↗
PubMed1999

Controversies in management of penetrating injuries of the pancreas.

The management of penetrating pancreatic injuries is still beset by controversy, especially with regard to the role of pancreatography, the most appropriate operation, the type of drainage and the adjunctive role of ocreotide. The recommendations of various experts are outlined and evaluated in the light of the authors' personal experience. Consensus is easily achieved for very minor and very severe injuries. Most management discussions center around those injuries resulting in parenchymal disruption of a degree of severity sufficient to raise doubts about the integrity of the main pancreatic duct.

Drainage↗
PubMed1998

Relaparotomies for abdominal sepsis--why, when, how? A collective review.

Despite numerous reports in the recent literature, the indications for relaparotomies for abdominal sepsis are still not clear cut. In particular there is no consensus concerning the decision or the optimal time to reoperate. There is more benefit than hazard in a low threshold for surgically exploring the critically ill patient, especially the one who cannot easily be assessed clinically. Exclusive reliance on radiological confirmation of ongoing sepsis might delay diagnosis and treatment. Relaparotomy at regular intervals (preferably every 24-48 hours) should be done until complete eradication of sepsis is achieved.

Abdominal Abscess↗
PubMed1997

Calmodulin-related changes in microsomal membrane fluidity during liver regeneration.

Based on our previous findings on the modifying effect of calmodulin (CaM) on the physiochemical properties of biomembrane, we have investigated the possible relationship between intracellular CaM content and endoplasmic reticulum (ER) membrane fluidity and function during liver regeneration. The degree of ER membrane fluidity was estimated by fluorescence polarization analysis with the 1,6-diphenyl-1,3,5-hexatriene probe. Microsomal guanylate cyclase (GC) was used as a functional parameter. The kinetics of the increase in the ER membrane fluidity during liver regeneration was strictly parallel to the CaM surge and was matched by an increase in GC activity. The stimulative effect of splenectomy on liver regeneration and its inhibition by Walker-256 tumor, inferred from the corresponding alterations of CaM levels, were mirrored by the modulation in GC activity. The fluidizing effect of CaM on ER membrane was concluded from the drop in thermotropic transition temperature from 28.3 +/- 1.6 degrees C in control membranes to 17.8 +/- 1.1 degrees C membranes from regenerating livers and to 19.8 +/- 1.2 degrees C in control membranes treated with CaM. Arrhenius plots of GC activity exhibited a transition temperature of 25.5 +/- 1.25 degrees C in controls, which shifted to 20.5 +/- 0.9 degrees C in ER membranes from regenerating livers and to 21.7 +/- 1.1 degrees C in control membranes treated with CaM. The Hill coefficient for the allosteric activation of the GC by Mn.GTP decreased from 1.49 +/- 0.16 in controls to 0.93 +/- 0.085 in membranes from regenerating cells and to 0.86 +/- 0.073 in CaM-treated membranes. Both effects of CaM were consistent with a fluidity increase in the enzyme's lipid microenvironment. The results of the present study suggest that an early key event in liver regeneration may be the CaM-induced modulation of ER membrane fluidity and function.

Animals↗
PubMed1997

Gunshot injuries of the abdominal aorta: a continuing challenge.

This is a retrospective study of 57 patients with gunshot injuries of the abdominal aorta. The aortic repair was achieved by various means: lateral aortorraphy, patch aortoplasty and graft insertion. There was an 85 per cent mortality rate from bleeding or secondary coagulopathy directly related to the aortic injuries. The need for resuscitative thoracotomy, shock, lack of response to fluid resuscitation and intraperitoneal bleeding were directly related to mortality. We feel that shortening of prehospital transfer time will increase the absolute number of patients surviving this grave injury.

Adolescent↗
PubMed1997

The management of urinary tract injuries after gunshot wounds of the anterior and posterior abdomen.

Gunshot wounds of the urinary tract are seen with increasing frequency due to the widespread use of firearms. There is much controversy regarding the optimal preoperative diagnostic evaluation and intraoperative management of such injuries. Debate also arises as to the need for mandatory exploration or the safety of non-operative management for carefully selected patients. Seventy-nine prospective patients with injuries of the urinary tract after a truncal GSW were analyzed. The incidence of renal repair, nephrectomy, bladder repair and ureteral repair was 14, 21, 27 and 9 per cent, respectively. Five (6 per cent) patients were managed non-operatively and 16 (20 per cent) more underwent abdominal but not renal exploration. From 21 (26.5 per cent) cases with complications, only three (4 per cent) patients developed complications which were associated with the urinary tract injuries. Although the majority of patients with GSWs of the urinary tract will require abdominal exploration, invasion of Gerota's fascia may be spared in cases of stable renal haematomas. A high index of suspicion followed by adequate exploration is required to avoid missed ureteral injuries. Bladder perforations almost always require surgical repair.

Adult↗
PubMed1997

Management of penetrating injuries of the cervical trachea.

This is a report of a 2-year experience with the management of penetrating injury of the cervical trachea. There were 29 cases. The respiratory status of the patient on admission dominated the initial management: 12 patients required emergency intubation and were immediately taken to operation, while 17 patients were more stable and could be subjected to the preoperative assessment of the oesophagus. Associated injuries were significant and dominated the postoperative morbidity and mortality. Primary repair of the trachea, without tracheostomy, was successful in a relatively high proportion of patients (55%).

Adult↗
PubMed1997

Audit of acute appendicitis in a black South African population.

This is a prospective study of 212 black South African patients operated on with a pre-operative diagnosis of acute appendicitis. There were 143 male and 69 female patients. Forty-four patients had normal appendices and 122 non-perforated and 46 perforated acute appendices. The appendix was normal in 12 male and 32 female patients. Most presenting signs had a high positive predictive value but few had a high negative predictive value. There was no significant difference in the systemic response between perforated and non-perforated groups. Delay in presentation accounted for the majority of perforated appendices, while there was no causal relationship between in-hospital observation and perforation. The complication rate was higher and hospital stay longer in the perforated group. We concluded that the presentation and clinical course of acute appendicitis in the population of black South Africans catered to by our hospital is not very different from that in the white population elsewhere in the world.

Acute Disease↗
PubMed1996

Diaphragmatic herniation after penetrating trauma.

A study was made of 45 patients with diaphragmatic herniation after penetrating trauma. In 29 the diagnosis was established during the first admission (early presentation) and in 16 during a subsequent admission (delayed presentation). The mortality rate in the early presentation group was 3 per cent compared with 25 per cent in the delayed presentation group. The presence of gangrenous or perforated abdominal viscus in the chest cavity was the single most common and severe aggravating factor. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasized. As isolated diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate investigations and good follow-up are of paramount importance in preventing late herniation of intra-abdominal viscera through a penetrating diaphragmatic injury.

Adult↗
PubMed1996

Gunshot injuries of the head of the pancreas: conservative approach.

This study is comprised of 48 patients with gunshot injuries of the head of the pancreas, many of which were high velocity injuries. The purpose of this study was to evaluate our management policy for these injuries based on our recent wide experience. Patients with grade II and III injuries underwent conservative surgery, with 0% and 21% postoperative mortality, respectively, directly related to the pancreatic injury. For patients in whom the duodenum was involved, pyloric exclusion was applied depending on the grade of the duodenal injury. We concluded that moderate gunshot injuries of the head of the pancreas (grade II) can be safely treated by débridement and suture repair, with or without drainage. Severe (grade IV) injuries warrant a pancreaticoduodenectomy. Most grade III injuries can be treated by débridement and drainage unless an associated severe duodenal injury is present, in which case resection may be indicated.

Adult↗
PubMed1996

Gunshot arterial injuries to the groin: comparison of iliac and femoral injuries.

In a prospective study of 69 patients with gunshot arterial injuries to the groin, there were 18 patients with iliac and 51 with femoral artery injuries. In the former group, the majority of patients were admitted with gross physiological derangement that did not respond to pre-operative resuscitation, so were taken directly to theatre. There was a 39 per cent peri-operative mortality. A prompt operation is mandatory to improve the chances of survival of patients with this injury. In the latter group all patients responded to pre-operative resuscitation and in the great majority, the diagnosis was established by the presence of 'hard' signs of arterial injury alone. There was a 4 per cent amputation rate and no mortality.

Adolescent↗
PubMed1996

Selective surgical management of zone II gunshot injuries of the neck: a prospective study.

BACKGROUND: The management of penetrating neck trauma remains controversial, with many studies supporting either mandatory exploration or selective conservatism. METHODS AND RESULTS: This is a prospective study of 75 patients with gunshot injuries to zone II of the neck. Forty patients (53.3%) underwent immediate exploration because of clinical indications or positive initial investigations. A 7.5% incidence of unnecessary explorations, a 5% mortality rate, and average hospital stay of 10.5 days were noted. Thirty-five patients with negative clinical or investigational findings underwent observation with constant monitoring. A 5.7% incidence of missed injuries, no mortality, and an average hospital stay of 3.5 days were noted for these patients. CONCLUSIONS: We suggest that conservative management in gunshot injuries confined to zone II of the neck selectively supplemented by appropriate investigations is a viable proposition in this type of injury. Further contemporary studies reporting specifically on this injury will enable us to reach statistically significant conclusions.

Adolescent↗