Biomedical subjects

Emmanouil Pikoulis

Publications and source records attributed to Emmanouil Pikoulis.

16 recordsLinked to original sources

PubMed2006

Vascular endothelial growth factor polymorphisms in gastric cancer development, prognosis, and survival.

BACKGROUND: Angiogenesis plays an important role in growth, progression, and metastasis of tumors. Vascular endothelial growth factor (VEGF) overexpression has been associated with advanced stage and poor survival in several cancers. METHODS: The association of functional single nucleotide polymorphisms (SNPs) of VEGF gene with gastric cancer development, prognosis, and survival in a case-control study of 100 gastric cancer Greek patients was evaluated. The genotyping was performed by PCR-RFLP analysis. RESULTS: Our results revealed a marginally significant association of the 634CC genotype (P = 0.042) with increased risk for gastric cancer development. None of the rest of the examined polymorphisms or haplotypes conferred any gastric cancer susceptibility. A strong association between the -2578AA (P = 0.025), -634CC (P = 0.013), +936CT (P = 0.028), +936TT (P = 0.0001) genotypes and a larger tumor size was observed, while the 2578AA and -634CC genotypes were strongly correlated to poor differentiation (P = 0.01) and advanced stage of disease (P = 0.039), respectively. In addition, our results indicated that metastatic disease frequency was more accentuated among the +936TT carriers (P = 0.0035). Interestingly, carrying the -634CC genotype was associated with decreased overall survival rates (46.67%). CONCLUSIONS: The present study suggests that VEGF polymorphisms may contribute to gastric tumor characteristics; these observations, however, requiring further confirmation in a larger multi-ethnic study.

Aged↗

PubMed2006

Liver tissue dissection: ultrasonic or RFA energy?

BACKGROUND: Hepatic resection is the only potential curative treatment for a wide variety of conditions. However, liver surgery is technically demanding and closely associated with a number of serious complications. New devices and techniques are currently being applied in practice, which will improve the surgical outcome. METHODS: This retrospective study compares two methods of liver parenchymal division: ultrasound energy, a modern but already widely used technique, and radio-frequency ablation (RFA), a completely novel method. The parameters investigated include the amount of blood transfused, the necessity of the Pringle maneuver, the length of time required for parenchymal division, and postoperative morbidity and mortality. The patients were divided into two groups. In one group (Group A), 15 patients underwent 17 ultrasound-assisted liver resections, in which ten metastatic tumors, six hepatomas, and one cholangiocarcinoma were resected. In Group B, 21 patients underwent 22 RFA-assisted hepatectomies in which 11 metastatic tumors, ten hepatomas, and two cholangiocarcinomas were removed. RESULTS: Thirteen patients (87%) in Group A and 11 (52%) in Group B received a transfusion, with an average of 3.5 and 1.6 units of red blood cells, respectively. The Pringle maneuver was necessary in two cases in Group A but was unnecessary in Group B. The mean length of time required for parenchymal dissection was 124 min in Group A and 93.18 min in Group B. One (6.7%) and four (19%) complications were observed in Group A and B, respectively (statistically not significant). Mortality remained zero in both groups. CONCLUSIONS: RFA energy provides a novel reliable and safe alternative that can be used exclusively or as a supplement to the older techniques. Both resection time and amount of blood transfusion were reduced in the RFA group.

Adult↗

PubMed2006

Laparoscopic esophagomyotomy for achalasia without a complementary antireflux procedure.

BACKGROUND: Achalasia is a progressive motility disorder of the esophagus, without a definitive cure. The principal method of palliation is myotomy of the distal esophagus. We analyzed the 5-year experience at our institution with laparoscopic Heller myotomy without an antireflux procedure to determine its results, particularly regarding postoperative gastroesophageal reflux. MATERIALS AND METHODS: Thirty-three patients, mean age 43 years (range, 29-62 years) with clinical, manometric, x-ray, and endoscopic proof of achalasia were operated on and followed up for 24 months. Prior to being referred to surgery they had all undergone at least one pneumatic balloon dilation. The operative technique was a 7-cm myotomy that included the lower esophageal sphincter but did not exceed 5 mm of the gastric cardia. Follow-up consisted of clinical observation, cineesophagography, and 24-hour pHmetry. RESULTS: All patients reported satisfactory to excellent results regarding dysphagia and no heartburn two years after the operation. The 24-hour pHmetry and the radiographic investigation showed no evidence of gastroesophageal reflux. CONCLUSION: It seems that the risk of gastroesophageal reflux is very low when the cardiomyotomy does not exceed the length of 5 mm. Our results are in accordance with other observational studies as well as larger cohort and meta-analysis studies. Prospective randomized studies are needed to clarify the role of an antireflux procedure after laparoscopic Heller myotomy.

Adult↗

PubMed2006

Radio frequency ablation (RFA)-assisted pericystectomy for hepatic echinococcosis: an alternative technique.

The aim of this study is to describe an alternative technique, using radio frequency energy to perform pericystectomy for hepatic echinococcosis. We present 3 patients with hepatic echinococcosis who were treated with radio frequency ablation (RFA)-assisted pericystectomy. A Radionics Cooltip Radio Frequency System (Tyco, Greece, Radionics) with a single shaft 15 cm long needle electrode and a 2 cm exposure tip, was used. The needle electrode was inserted in consecutive sites into the "healthy" hepatic parenchyma close to the cyst wall, so that a tissue zone around the cystic cavity was gradually ablated. The complete ablation of a site was followed by sharp division of the parenchyma. The operation completed successfully in all patients. Minor bleeding and/or bile leakage were successfully controlled with RFA coagulation. No other hemostatic method was used. The postoperative course was uneventful. No evidence of recurrent disease, or any other cause of morbidity, has been demonstrated at follow up (2 y). RFA-assisted pericystectomy for hepatic hydatid disease in experienced hands, might be useful to perform a "sterile" resection, eradicating single or multiple cysts and preventing local recurrence, with minimal morbidity.

Adult↗

PubMed2006

Open reconstruction of sizeable ventral hernias in the laparoscopic era.

The purpose of this study was to review our 15 years of experience in the repair of sizeable ventral hernias with a standardized open surgery technique, to evaluate the clinical outcome, and to assess the decreasing role of traditional surgical techniques in the laparoscopic era. A retrospective study has been conducted, including 200 patients operated for ventral hernia defects with a standardized underlay mesh implantation technique between 1990 and 2004. Their mean age was 62.6 (range 21-88) years and their mean BMI (body mass index) was 33.4 (range 22-69). Out of them, 56 per cent presented one to four major risk factors and 31.5 per cent had previously undergone ventral hernia repair surgery. The mean size of hernial defect was 135.2 (range 24-684) cm2. The mean follow-up was 43 (range 3-174) months. The overall major complication rate was 3.8 per cent and overall recurrence rate was 9.6 per cent. Our retrospective study confirms the safety and efficacy of open reconstruction in complex hernias. Prospective randomized homogenous trials with long-term follow-up are needed to provide us a better evidence-based approach. Minimal invasive surgery is favored but open reconstruction should still be considered as an alternative for sizeable ventral hernias management. A careful selection among patients for selecting the optimal technique is necessary.

Adult↗

PubMed2006

Emergency helical CT scan in acute abdomen: a case of intestinal intussusception.

Surgeons are familiar to the nosological entity "partial intestinal obstruction". Intussusception constitutes a rare etiologic factor for this entity but usually remains undiagnosed preoperatively. Several imaging techniques have been proposed as useful in the diagnosis of intussusception but none of these has a remarkable sensitivity and specificity. In the following case of partial intestinal obstruction, we performed an helical CT scan of the abdomen. The method revealed with an excellent accuracy the nature (intussusception) and the location (ascending colon) of the partial intestinal obstruction. Having the extra advantage of the shorter examination time than the classical CT scan, we propose the helical CT as an alternative diagnostic modality for preoperative evaluation of patients with partial intestinal obstruction.

Abdominal Pain↗

PubMed2005

Marlex mesh Prefix plug hernioplasty retrospective analysis of 865 operations.

For 5 years (January 1998 to November 2002) our department has applied the Marlex Mesh Perfix Plug hernioplasty. This article demonstrates the experience gained in operative and postoperative aspects, costs, and outcome along with the results of a follow-up analysis. Altogether, 801 patients (749 males, 52 females) were operated on Sixty-four males had bilateral groin hernias, so the total number of hernioplasties amounted to 865. A total of 19 hernias were recurrent, 297 were direct, 545 were indirect or scrotal (or both) 21 were femoral, and 2 were Spigelian. Fifty-three operations were performed on an emergency basis. Preoperative routine use of antibiotics was minimized throughout the years. Operating time fluctuated from 20 to 25 min (30-40 minutes for recurrent hernias), and the postoperative hospital stay was 28 hours (6-72) hours. The complication rate was 5% and the recurrence rate less than 1%. Early patient mobilization and return to everyday activities (1-2 weeks) was encouraged. The follow-up of 95% of the patient population lasted 12 to 60 months and was performed at 1 week, 1 month, 1 year, and yearly thereafter. The technique demonstrates less overall postoperative pain, discomfort, and complications combined with a remarkably low recurrence rate. The rapid rehabilitation with great patient comfort and decreased operating room time, resulting in lower financial costs, have led us nowadays to repair all types of inguinal hernias, femoral and recurrent ones, using this technique.

Female↗

PubMed2005

Primary rhabdomyosarcoma of the lung arising over cystic pulmonary adenomatoid malformation.

The authors report the case of a 2-year-old girl with pulmonary cystic adenomatoid malformation type II who presented with a mass on the lower lobe of the left lung. Resection and histological examination revealed pleomorphic rhabdomyosarcoma. Chemotherapy and radiotherapy followed the operation and the girl is alive and in perfect condition 10 years after the operation. The literature on primary rhabdomyosarcoma of the lung in children is reviewed.

Child, Preschool↗

PubMed2004

A new spleen-preserving technique using radiofrequency ablation technology.

BACKGROUND: Splenic salvage is the ultimate goal of the treatment for splenic injury. We experimentally investigated a spleen salvage technique after spleen injury using radiofrequency ablation technology. METHODS: A grade IV spleen trauma was produced in 10 white male Landrace pigs (the lower pole of the spleen was sharply divided at the level where the lower hilar vessel enters the organ) under general anesthesia. A Radionics Cooltip Radio Frequency needle was used to stop the bleeding in every case. The electrode was inserted in four to six different sites and each session lasted for 2 to 6 minutes. RESULTS: All bleeding sites were controlled intraoperatively with no additional means. Postoperatively, all animals appeared clinically healthy, and at the time the animals were killed, no blood, pus, or other fluid was identified in the abdomen or chest. Subcapsular or perisplenic hematomas were not found either. CONCLUSION: We believe that radiofrequency ablation may be used in splenic injury to stop bleeding, especially when blood transfusion or surgery is indicated. This procedure may reduce the frequency of open surgery for repair of the injury, the number of splenectomies, and the amount of blood transfusion required. The advantage of use under ultrasound or computed tomographic guidance or laparoscopically makes it even more appealing. Thus, we suggest that further study in human subjects is required to validate our results.

Animals↗

PubMed2004

A case of blunt abdominal trauma and posttraumatic acute appendicitis.

Acute appendicitis and blunt abdominal trauma are common surgical emergencies. Whether there is a causative relationship between these two entities has long been a subject of debate. A twenty-one-year-old male Japanese tourist presented with vague abdominal pain and dysuria that began after he had been beaten and robbed. No signs of trauma were detected on physical examination; however, there were diffuse abdominal sensitivity with maximal tenderness in the hypogastrium and rebound tenderness in the right lower quadrant. Upon no improvement with medications within 24 hours, laparotomy was performed, which revealed an inflamed appendix, a few enlarged mesenteric lymph nodes, and free peritoneal fluid that was found to be sterile. Following appendectomy, the diagnosis was confirmed by pathologic examination and the enlargement of the lymph node was attributed to non-specific reactive hyperplasia. The patient had an uneventful postoperative course, with relief of pain and fever.

Abdominal Injuries↗

PubMed2004

Radio-frequency tissue ablation in liver trauma: an experimental study.

The liver is the most frequently injured intra-abdominal organ. Radio-frequency tissue ablation (RFA) with cooled tip electrodes is here experimentally used for the treatment of liver trauma. A grade III and a grade III to IV trauma each were produced in the livers of 10 domestic pigs. RFA was applied around the sites of injury until hemostasis was achieved. The animals were sacrificed at 0, 3, 7, 14, and 21 days and examined. The livers were subjected to histologic and radiologic examination. Two similar traumas were created in the livers of two more animals and were left surgically untreated as a control group. The two untreated animals died immediately postoperatively, proving the severity of the injuries. Hemostasis was achieved in all treated animals. Mortality and morbidity were zero. No blood, pus, bile, or other fluid was found in the abdomen at sacrifice. A three-zone pattern of lesion was recognized around the electrode placement at histology. RFA is an efficient and safe hemostatic method for grade III and grade III to IV hepatic trauma. Further studies are required for its use in humans.

Animals↗

PubMed2003

Acquired bladder diverticula can mimic obstructive extrabiliary jaundice.

A rare case that relates benign prostatic hyperplasia-associated bladder diverticula and obstructive uropathy to extrabiliary obstructive jaundice in an older patient is presented. Immediate decompression of the bladder allowed for prompt restoration of the biliary drainage and normalization of the creatinine within a few days. A hepatobiliary etiology was discarded through prompt radiologic and serologic testing along with computed tomography-guided liver biopsy. Long-term management included open suprapubic prostatectomy and diverticulectomy. This unusual case expands the amount of sound anatomic and pathophysiologic links between urinary and extraurinary manifestations.

Aged↗

PubMed2003

Microthrombectomy reduces postsclerotherapy pigmentation: multicenter randomized trial.

OBJECTIVE: Postsclerotherapy pigmentation occurs in nearly 30% of patients. Hemosiderin, from degradation of the venous thrombus, is the possible cause. The hypothesis that early removal of the thrombus may eliminate or decrease the incidence of pigmentation has not been proved or documented. The objective of this study was to investigate the effects of early microthrombectomy on incidence of postsclerotherapy pigmentation. MATERIAL AND METHODS: This multicenter, randomized, controlled study involved 101 patients with varicose veins (100 women, 1 man; mean age, 46 years [range, 25-68 years]). Patients were divided into two groups, with veins 1 mm or less in diameter (group 1, n = 50) or veins 3 mm or less in diameter (group 2, n = 51). Group 1 was treated with Sotradecol (STD) 0.25%, and group 2 with STD 0.50%. In each patient, an area of varicosities was selected and divided into halves. One half was randomized to microthrombectomy and the other half served as control. Microthrombectomy was performed 1 to 3 weeks after treatment in the randomized half. Standard photographs were obtained before and 16 weeks after treatment, and were evaluated by three independent reviewers who were blinded to treatment assignments. Each reviewer received an identical set of pretreatment and posttreatment 10 x 15-cm color photographs of the study area, and completed a scoring sheet. Average of the scores was used to evaluate primary (pigmentation) and secondary (overall clinical improvement) end points. The paired t test and chi-square test were used for statistical analysis. RESULTS: In group 1, microthrombectomized areas had statistically significant less pigmentation (P =.0047) and better overall clinical improvement scores (P =.0002) compared with the control side. In group 2 there was no significant difference between the two areas, but patients reported significant relief of pain and inflammation associated with postsclerotherapy thrombophlebitis. CONCLUSION: In veins 1 mm or smaller, microthrombectomy reduced pigmentation and improved overall clinical results. In veins 3 mm or smaller, statistical significance was not achieved, but thrombectomy resulted in faster resolution of the postsclerotherapy pain and inflammation. On the basis of these results, microthrombectomy after sclerotherapy is recommended.

Adult↗

PubMed2002

Abdominal aortic aneurysm associated with a horseshoe kidney and renal carcinoma: a case report.

A horseshoe kidney is the most common renal embryological abnormality, but its association with an abdominal aortic aneurysm is rare. The conbination of a horseshoe kidney with a renal carcinoma and an abdominal aortic aneurysm is extremely rare and, to our knowledge, has only been reported twice in the English literature (Hinyokika kiy 46 (2000) 15; Eur J Vasc Endovas Surg 22 (2001) 280).

Aortic Aneurysm, Abdominal↗

PubMed2002

Laparoscopic preperitoneal mesh repair or tension-free mesh plug technique? A prospective study of 471 patients with 543 inguinal hernias.

OBJECTIVE: To compare two modem mesh-based "tension free" hernioplasties, laparoscopic repair and mesh plug technique. DESIGN: Prospective, non-randomised study. SETTING: Two major medical centres, Greece. SUBJECTS: 471 patients with 543 inguinal hernias. INTERVENTION: Patients entering the study were treated in two major medical centres either by laparoscopic repair under general anaesthesia (n = 237) in hospital A, or by insertion of a mesh plug under monitored local, epidural, or spinal anaesthesia (n = 234) in hospital B. Patients with known bilateral inguinal hernias, femoral hernias, and those with both inguinal hernias and cholelithiasis were encouraged to undergo laparoscopic repair. MAIN OUTCOME MEASURES: Operative time, hospital mortality, morbidity and length of stay, costs, time to return to work, and recurrence rate. RESULTS: The median operative time for laparoscopic repair was significantly longer (57 compared with 33 minutes, p < 0.001). Laparoscopic repair was more costly (1,200 US dollars compared with 500), and technically more demanding than insertion of a mesh plug. The median postoperative hospital stay, consumption of narcotic analgesics, and return to full work and heavy activities were similar in the two groups, whereas light activities were started earlier after plug repair [5.4 (2.4) compared with 3.4 (1.5) hours, p < 0.0001]. There were 6 recurrences in the laparoscopic group and 1 in the plug group. CONCLUSIONS: Mesh plug insertion is faster, cheaper, technically easier, does not require general anaesthesia, and is suitable to be done by surgeons as part of their general practice without special instruments and by junior surgeons. Plug repair resulted in fewer short or long term complications and reduced the recurrence rate.

Costs and Cost Analysis↗

PubMedDate not supplied

Blunt trauma to the extrahepatic biliary tract. A multicenter study.

BACKGROUND/AIMS: Blunt trauma to the extrahepatic biliary tract is a rare and challenging injury The purpose of this paper is to review our experience of these injuries, with special reference to their clinical presentation. PATIENTS AND METHODS: In a retrospective multicenter study of the records of a trauma-admitting in three hospitals, seven patients with blunt extrahepatic biliary tract trauma were identified, one with combined gallbladder and common bile duct injuries and six with a ruptured gallbladder. RESULTS: Except for the patient with the common bile duct injury developing peritoneal signs during observation and being operated 24 hours post-admission, all other patients underwent early laparotomy for shock, peritonitis or positive diagnostic peritoneal lavage (DPL) caused by associated injuries. The common bile duct injury was treated with suture repair over a T tube and the gallbladder injuries with cholecystectomy, except for two cases in which a cholecystostomy was performed. CONCLUSIONS: In patients with blunt trauma, especially to the right upper quadrant, a high index of suspicion and liberal use of diagnostic studies to exclude an isolated extrahepatic biliary tract injury is recommended.

Adult↗