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Biomedical subjects

E Sanidas

Publications and source records attributed to E Sanidas.

At least 19 recordsLinked to original sources
PubMed2006

Motor vehicle trauma: analysis of injury profiles by road-user category.

BACKGROUND: Vehicle accidents in Greece are among the leading causes of death and the primary one in young people. The mechanism of injury influences the patterns of injury in victims of vehicle accidents. OBJECTIVE: Identification and analysis of injury profiles of motor-vehicle trauma patients in a Greek level I trauma centre, by road-user category. PATIENTS AND METHODS: The trauma registry data of Herakleion University Hospital of adult trauma patients admitted to the hospital after a vehicle accident between 1997 and 2000 were retrospectively examined. Patients were grouped based on the mechanism of injury into three road-user categories: car occupants, motorcyclists, and pedestrians. RESULTS: Of 730 consecutive patients, 444 were motorcyclists (60.8%), 209 were car occupants (28.7%), and 77 were pedestrians (10.5%). Young men constituted the majority of injured motorcyclists whereas older patients (p = 0.0001) and women (p = 0.0001) represented a substantial proportion of the injured pedestrians. With regard to the spectrum of injuries in the groups, craniocerebral injuries were significantly more frequent in motorcyclists and pedestrians (p = 0.0001); abdominal (p = 0.009) and spinal cord trauma (p = 0.007) in car occupants; and pelvic injuries (p = 0.0001) in pedestrians. Although the car occupants had the highest Injury Severity Score (ISS) (p = 0.04), the pedestrians had the poorest outcome with substantially higher mortality (p = 0.007) than the other two groups. CONCLUSIONS: The results reveal a clear association between different road-user categories and age and sex incidence patterns, as well as outcomes and injury profiles. Recognition of these features would be useful in designing effective prevention strategies and in comprehensive prehospital and inhospital treatment of motor-vehicle trauma patients.

Accidents, Traffic↗
PubMed2005

Optical characterization of thin female breast biopsies based on the reduced scattering coefficient.

One of the main goals in optical characterization of biopsies is to discern between tissue types. Usually, the theory used for deriving the optical properties of such highly scattering media is based on the diffusion approximation. However, biopsies are usually small in size compared to the transport mean free path and thus cannot be treated with standard diffusion theory. To account for this, an improved theory was developed, by the authors, that can correctly describe light propagation in small geometries (Garofalakis et al 2004 J. Opt. A: Pure Appl. Opt. 6 725-35). The theory's limit was validated by both Monte Carlo simulations and experiments performed on tissue-like phantoms, and was found to be two transport mean free paths. With the aid of this theory, we have characterized 59 samples of breast tissue including cancerous samples by retrieving their reduced scattering coefficients from time-resolved transmission data. The mean values for the reduced scattering coefficients of the normal and the tumour tissue were measured to be 9.7 +/- 2.2 cm(-1) and 10.8 +/- 1.8 cm(-1), respectively. The correlation with age was also investigated.

Adipose Tissue↗
PubMed2005

Detection of CK-19 mRNA-positive cells in the peripheral blood of breast cancer patients with histologically and immunohistochemically negative axillary lymph nodes.

BACKGROUND: To investigate the incidence of direct hematogenous spread of cancer cells in patients with early-stage breast cancer by studying the presence of occult tumor cytokeratin-19 (CK-19) mRNA(+) cells in the peripheral blood in relation to the status of sentinel (SLNs) and (ALNs) axillary lymph nodes. PATIENTS AND METHODS: SLNs and ALNs from 111 patients with operable stage I-II breast adenocarcinoma were evaluated for the presence of tumor cells by hematoxylin-eosin (H&E) staining and, if negative, by immunohistochemistry (IHC) using an anti-CK-19 antibody. Peripheral blood was also analyzed for the presence of CK-19 mRNA(+) cells by nested RT-PCR, before the initiation of adjuvant treatment and in CK-19 mRNA(+) patients following the completion of adjuvant chemotherapy and hormonal treatment. RESULTS: After both H&E staining and IHC analysis, 29 (26%) patients were ALN negative (N0). In 78 (70%) patients H&E staining and in four (3.6%) IHC analysis revealed tumors cells, and these patients were considered as ALN positive (N+). Peripheral blood CK-19 mRNA(+) cells were detected in nine (31%) out of 29 N0 and in 31 (38%) out of 82 N + patients (P=0.5) before any adjuvant treatment. Adjuvant chemotherapy and hormone treatment resulted in the disappearance of the CK-19 mRNA(+) cells in all N0 patients and in 15 out of 31 N + patients. After a median follow-up of 40 months, all the N0 CK-19 mRNA(+) patients were relapse-free whereas four (13%) N + CK-19 mRNA(+) patients had relapsed. CONCLUSIONS: Direct hematogenous dissemination of occult tumor cells may occur in a substantial proportion of patients with early-stage breast cancer. The prognostic implication of the detection of these cells requires long follow-up periods and further studies.

Adenocarcinoma↗
PubMed2003

Axillary lymphadenectomy for breast cancer - the influence of shoulder mobilisation on lymphatic drainage.

AIM: The purpose of the present study was to study the influence of external axillary compression dressing with immobilisation of the ipsilateral shoulder after axillary lymph node dissection (ALND) on postoperative axillary drainage. METHODS: One hundred consecutive women with breast cancer undergoing ALND were enrolled in this study. They were allowed free shoulder movement and were compared with a matched historical control group of 60 patients, in whom the ipsilateral arm was immobilised for four days. For all patients the amount of drainage was recorded each postoperative day until drain removal. Prognostic data on drainage amounts and duration were gathered from all patients. Complications were recorded. RESULTS: Hospital stay was the only statistically significant difference between the two groups, it was prolonged for patients with immobilisation of the arm. The parameters found to influence the drain production with a statistically significant difference were body mass index and the removal of more than 10 lymph nodes. Postoperative complications were similar in both groups. CONCLUSIONS: External compression dressing of the axillary cavity with immobilisation of the ipsilateral arm has no impact on the postoperative drainage volume and duration. It is associated with adverse effects, such as discomfort, prolonged hospital stay and shoulder stiffness.

Adult↗
PubMed2001

Obesity-associated disorders before and after weight reduction by vertical banded gastroplasty in morbidly vs super obese individuals.

BACKGROUND: The amount of excess weight which must be lost in order to cure or to improve disorders associated with obesity remains unknown. This study was designed to compare super obese and morbidly obese patients in terms of weight reduction following VBG and to investigate the effects of postoperative weight changes to preexisting co-morbidities. METHODS: 125 patients underwent VBG. Group A consisted of 80 morbidly obese patients (64%) and group B consisted of 45 super obese patients (36%). Preoperative examination was planned to identify and determine the severity of any disorders associated with obesity, that the patients may have had. Following VBG, all patients were followed-up at regular time periods, for at least 2 and up to 4 years. The progress of preexisting co-morbidities was evaluated and carefully recorded. RESULTS: Among the 80 patients of Group A, there were 240 total co-morbidities (3 per patient), and in group B there were 196 co-morbidities (4.35 per patient) preoperatively. Dyspnea during fatigue and arthritis were found at statistically higher incidence in the super obese category. At the end of the second postoperative year, greater weight loss in terms of number kilograms was seen in patients in group B, but these patients did not reach a BMI lower than 35, while patients in group A had mean BMI below 30. In group A, 66% of the co-morbidities completely resolved, 19% significantly diminished and 15% remain unchanged. In group B, the respective percentages were 53%, 27.5% and 19.5%. However, after weight reduction by VBG a significant number of co-morbidities remain in the super obese patients (92 or 2.044 per/patient), and this is believed to be due to the greater remaining excess weight. CONCLUSION: Reduction of body weight by VBG is associated with resolution or improvement of a significant number of the obesity-associated disorders. However, super obese patients remain obese after surgery, and this results in two-fold higher remaining morbidity.

Adult↗
PubMed2000

Management of simple thoracic injuries at a level I trauma centre: can primary health care system take over?

BACKGROUND: Overtriage is a problem for all trauma systems, including the Greek emergency system. In this study we examined the performance of the primary care emergency system in the treatment of patients with simple thoracic injuries, in the area of a Level I hospital. Our aim was to form organizational proposals and treatment and referral guidelines in an effort to improve the system's performance. METHODS: We reviewed the notes of 488 patients with a thoracic injury as their main complaint, seen and immediately discharged from the A+E department of a Level I hospital. RESULTS: Falls and road traffic accidents were the most common mechanisms of injury. The majority of the injuries were rib fractures or rib cage contusions. Many patients sought medical advice several days after the injury. Fifteen patients required conservative treatment for orthopaedic injuries. Clinical examination, X-rays and abdominal ultrasound were the most useful tests. CONCLUSIONS: Detailed clinical examination, time from injury and a chest X-ray usually identifies the patients who can safely be treated in primary health care facilities. Simple radiology services (X-ray and US) and training of general practitioners in basic emergency care principals in primary care health centres would reduce the number of referred patients with simple thoracic injuries.

Accidental Falls↗
PubMed1999

Peritoneal expansion by artificially produced ascites during perfusion chemotherapy.

HYPOTHESIS: In cases of peritoneal carcinomatosis, continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC) accomplishes homogeneous distribution of the drug and heat to the entire peritoneal cavity and exposure of the visceral and parietal surfaces to the perfusate. A new closed technique for expansion that produces artificial ascites is safer for medical personnel because of less heat and drug loss and more efficacious in its hemodynamic effect on the patient. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Twenty-one patients with peritoneal carcinomatosis. INTERVENTIONS: We performed 23 continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC) procedures with peritoneal cavity expansion to an intra-abdominal pressure up to 26 mm Hg, using artificially produced ascites with 4 to 9 L normal saline solution. MAIN OUTCOME MEASURES: Intraoperative and postoperative complications and hemodynamic changes during CHPPC. RESULTS: No intraoperative complications were recorded. The artificially produced ascites did not cause significant hemodynamic changes. During the immediate postoperative period, 1 patient died of intra-abdominal hemorrhage and leakage of a colorectal anastomosis, resulting in a mortality rate of 4% in our series. Minor complications were seen in 14 patients. The complications were not attributable to the expansion technique. CONCLUSIONS: Our proposed modification of closed-circuit CHPPC appears to be well tolerated and safe in patients with a high tumor load, as well as for the theater personnel. It remains to be investigated whether the theoretical advantages of the proposed technique will also lead to better long-term results.

Ascites↗
PubMed1999

First-line treatment with mitoxantrone, methotrexate, vincristine, and carboplatine (MIMOC) plus cyclical hormonotherapy with tamoxifen and megestrol acetate in advanced breast cancer.

Fifty patients with stage IIIB and IV breast cancer entered a prospective study receiving combination chemotherapy consisting of mitoxantrone (8 mg/m2) on day 1, methotrexate (30 mg/m2) on day 1, vincristine (1 mg/m2) on day 2, and carboplatine (250 mg/m2) on day 2 (MIMOC), plus cyclical hormonotherapy with tamoxifen (20 mg daily, days 1-10) and megestrol acetate (160 mg daily, days 11-21). The regimen was repeated every 3 weeks. None had received chemotherapy for advanced disease, although 17 patients had previously received adjuvant chemotherapy and 21 had received adjuvant hormonotherapy with tamoxifen. Twenty-seven patients had positive estrogen receptor (ER+) status, and 23 negative estrogen receptor (ER-) status. Response was observed in 31 (62%) of the 50 analyzed patients (95% CI: 48.5-75.4%), with 5 complete responses (10%). A significantly better response rate was observed in ER+ patients (p = 0.03). The median duration of response was 16 months, and the median time to disease progression was 18 months. The median overall survival was 19 months (27 for responders and 7 for nonresponders). ER+ patients had a higher probability of survival (p = 0.02). Toxicity was moderate. Nausea/vomiting and myelotoxicity were the main side effects. In conclusion, MIMOC plus cyclical hormonotherapy represents a well-tolerated and effective first-line treatment for advanced breast cancer. The observed difference in response and survival in favor of ER+ patients warrants further investigation.

Adult↗
PubMed1998

Does draining the neck affect morbidity following thyroid surgery?

A prospective randomized study questioning the benefit of neck drainage in thyroid surgery is presented. Two hundred consecutive patients, candidates for elective thyroid surgery, were randomized into Group A (no drain) and Group B (drain). Reoperation for bleeding was necessary for two patients of Group A and for one patient in Group B. Minor hematomas occurred in seven patients from Group A and five patients from Group B; wound infection occurred in two and four patients in Groups A and B, respectively; and lymphatic discharge occurred in two patients from Group B. These differences were not statistically different. The present study failed to demonstrate any protective value from the use of drains. However, the hospital stay was shorter and pain scores were smaller in the non-drain Group A.

Drainage↗
PubMed1997

Primary intrahepatic biliary cystadenomatous tumors.

BACKGROUND: Biliary cystadenoma and cystadenocarcinoma are rare tumors. The clinical features of, and optimal surgical management for these lesions have not been defined clearly. In this report, we describe three cases of cystadenomatous tumors of the biliary tract: two of a cystadenoma and one of a cystadenocarcinoma. The differential diagnosis of the cystic tumors of the liver in countries with a high prevalence of liver hydatid disease is very important. METHODS: The authors report their institution's experience from 1988 to 1995 in treating two cystadenomas and one cystadenocarcinoma and review previously reported cases in the literature. RESULTS: Clinical presentation is usually mild and atypical. During operation, the mass was resected en bloc with a margin of normal liver tissue in the cases of cystadenomas and, in the case of cystadenocarcinoma, a left hepatectomy with drainage of the common bile duct was performed. The two patients with adenomas remain well at 1 and 7 years after operation and our patient with adenocarcinoma is free of disease 8 years later. CONCLUSIONS: The treatment of choice is radical excision of the mass, either with a wide margin of normal liver or by means of a typical lobectomy, depending on the size and location of the lesion. When the lesion can be removed completely, the prognosis is excellent.

Adult↗
PubMed1997

Malignant melanoma of the penis.

A case of malignant melanoma of the penis is herein reported. Malignant melanoma of the penis is rare and accounts for a small percentage of malignant melanomas and of malignant penile lesions. The diagnosis is often delayed by the patient's reluctance to consult a physician and by the intrinsic difficulty in clinical diagnosis of such a rare neoplasm. The surgical treatment is not standardized and is shortly discussed. In general, prognosis is poor and most patients die within a few years due to distant metastasis.

Humans↗
PubMed1995

Expression of transforming growth factor alpha, epidermal growth factor receptor and epidermal growth factor in precursor lesions to gastric carcinoma.

Epidermal growth factor (EGF), its related peptide transforming growth factor (TGF-alpha) and their common receptor (EGFR) have been implicated in the control of cell proliferation and differentiation in the gastrointestinal epithelium and may play an important role in gastric carcinogenesis. We compared the immunohistochemical expression and topographic distribution of these peptides using Western blot analysis in gastric carcinoma precursor lesions and in non-cancer tissue. We observed: (i) increased and extended expression of TGF-alpha in normal mucosa and hyperplasia in carcinoma fields compared with non-cancer controls; (ii) increased expression of EGFR in intestinal metaplasia (IM) from carcinoma fields compared with controls; (iii) EGF expression was not detected in normal mucosa and only weakly in IM; (iv) coexpression of TGF-alpha/EGFR and EGF/EGFR was higher in intestinal metaplasia in carcinoma fields than in non-cancer controls. We conclude that altered expression of TGF-alpha/EGFR is associated with morphological changes during gastric carcinogenesis. In this regard increased expression of TGF-alpha is a very early event which is subsequently followed by up-regulation of EGFR and this has important biological and clinical implications.

Epidermal Growth Factor↗
PubMed1992

Primary cystadenomatous tumors of the bile ducts.

Two cases of cystadenomatous tumors of the biliary tract are presented. One was a cystadenoma and the other one was a cystadenocarcinoma. They are rare tumors, difficult to diagnose accurately preoperatively. The differential diagnosis of the cystic tumors of the liver in countries with a high incidence of liver hydatid disease is very important.

Adult↗
PubMedDate not supplied

Nitinol stents for palliative treatment of malignant obstructive jaundice: should we stent the sphincter of Oddi in every case?

PURPOSE: To evaluate the necessity of metallic stenting of the sphincter of Oddi in malignant obstructive jaundice when the tumor is more than 2 cm from the papilla of Vater. METHODS: Sixty-seven self-expandable biliary stents were used in 60 patients with extrahepatic lesions of the common hepatic or common bile duct and with the distal margin of the tumor located more than 2 cm from the papilla of Vater. Stents were placed above the papilla in 30 cases (group A) and in another 30 with their distal part protruding into the duodenum (group B). RESULTS: The 30-day mortality was 15%, due to the underlying disease. The stent occlusion rate was 17% after a mean period of 4.3 months. No major complications were noted. Average survival was 132 days for group A and 140 days for group B. In group A, 19 patients survived < or = 90 days and in eight of these, cholangitis occurred at least once. Of 11 patients in group A with survival > 90 days, only two developed cholangitis. In group B, 13 patients who survived < or = 90 days had no episodes of cholangitis and in 17 with survival > 90 days, cholangitis occurred in three. There is a statistically significant difference (p < 0.05) regarding the incidence of cholangitis in favor of group A. CONCLUSIONS: In patients with extrahepatic lesions more than 2 cm from the papilla and with a relative poor prognosis (< or = 3 months), due to more advanced disease or to a worse general condition, the sphincter of Oddi should also be stented in order to reduce the postprocedural morbidity.

Adult↗
PubMedDate not supplied

Pylorus-preserving pancreaticoduodenectomy with external pancreatic remnant drainage.

BACKGROUND: Pancreaticoduodenectomy is the mainstay of surgical treatment for various benign and malignant diseases of the head of the pancreas and the periampullar region. The incidence of postoperative morbidity remains significantly high. Various modifications have been advocated for the restoration of the digestive continuity and drainage of bile and pancreatic ducts in order to diminish this high morbidity rate. METHODS: A new modification with the combination of an end-to-end duodenojejunal anastomosis and creation of an external pancreatic fistula following pylorus-preserving pancreaticoduodenectomy is described. Our initial experience with this modification in seven patients is reported and its advantages are discussed. RESULTS: There was no mortality, while morbidity was 29%, including postoperative pneumonia and psychosis in one patient, and intra-abdominal abscess in another patient. No significantly delayed gastric emptying was observed and no patient developed diabetes, anastomotic ulcer or reflux cholangitis postoperatively. CONCLUSIONS: The reported technique seems to be a safe modification of restoration after pancreaticoduodenectomy, with maintenance of anatomical gastrointestinal continuity, avoidance of complications from anastomosis with the pancreatic remnant, as well as maintenance of endocrine pancreatic function. However, long-term follow-up and larger comparative studies are needed to evaluate the impact of this modification on morbidity and mortality, including long-term nutritional complications.

Adenocarcinoma↗
PubMedDate not supplied

Management of blunt hepatic and splenic trauma in a Greek level I trauma centre.

BACKGROUND AND PURPOSES: Non-operative management (NOM) has revolutionized the care of blunt hepatic and splenic trauma patients. The objective of this study is to evaluate treatment of such patients in a Greek level I trauma centre, to identify factors that are important for selecting them for NOM and to investigate for predictors of NOM failure. MATERIAL AND METHODS: We reviewed the Trauma Registry data of 96 consecutive adult patients admitted with blunt liver and/or splenic injuries over a 4-year period. RESULTS: Immediately operated patients (32.3%) had lower diastolic arterial pressure (p = 0.02), lower International Classification of Diseases -9th revision Injury Severity Score (ICISS) (p = 0.01), and a higher grade of splenic injury (p = 0.002) than NOM patients. NOM success rate was 80%. No predictors of NOM failure were found ; however, isolated splenic trauma patients failed NOM more frequently than hepatic patients (p = 0.02). CONCLUSIONS: NOM of adult blunt hepatic and splenic trauma patients is safe and efficient. Haemodynamic stability, ICISS and the grade of splenic injury are important for selecting these patients for NOM while splenic trauma patients need more intense observation.

Abdominal Injuries↗