PubMed Health⌕ Search

Biomedical subjects

George Anagnostopoulos

Publications and source records attributed to George Anagnostopoulos.

10 recordsLinked to original sources
PubMed2006

Effect of enhanced iron chelation therapy on glucose metabolism in patients with beta-thalassaemia major.

Recently introduced chelation regimens that combine deferoxamine (DFO) and deferiprone have been shown to have greater efficacy in promoting iron excretion than either chelator alone and have been associated with rapid reduction of the iron load in the heart and liver, and with reversal of cardiac dysfunction. It is unclear whether this combined therapy could be associated with a reduction in iron load or decline in the severity of iron-induced endocrinopathies. Starting in January 2001, 42 patients with beta-thalassaemia major, previously maintained on subcutaneous DFO only, were switched to combined treatment with DFO and deferiprone. The primary endpoint was to investigate the effects of this therapy on the glucose metabolism characteristics of this population. Combination therapy markedly decreased ferritin levels (638 +/- 1345 vs. 2991 +/- 2093 microg/l, P < 0.001). Glucose responses were improved at all times during an oral glucose tolerance test, particularly in patients in early stages of glucose intolerance. Glucose quantitative secretion also decreased significantly with combined therapy, while no significant change occurred in insulin levels in any group. Insulin secretion, according to the homeostasis assessment model, markedly increased in all groups, while overall reduction in insulin sensitivity did not reach statistical significance. This study showed that the combination of DFO and deferiprone was associated with an improvement in liver iron deposition and glucose intolerance.

Adolescent↗
PubMed2005

Elevation of serum liver enzymes after laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy (LC) has been accepted as an alternative to laparotomy, and has become the standard treatment of benign gallbladder diseases. However, it has been noticed that (following LC) the serum level of certain liver enzymes raises markedly in patients who had preoperatively normal liver enzyme values. METHODS: We measured serum values of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transferase, bilirubin, and international normalized ratio (INR) in 72 consecutive patients who underwent laparoscopic cholecystectomy and 36 consecutive patients who underwent open cholecystectomy (OC). During laparoscopic surgery, the intra-abdominal pressure was maintained at 14 mmHg of CO2. To assess liver function, serum liver enzymes were measured before operations and at 1,3,7, and 10 days postoperation. RESULTS: Mortality was nil. Twenty-four hours after the procedure, ALT and AST increased statistically significantly in the LC group (ALTLC24: 87.1+/-24.2 U/L P<0.001; ASTLC24:82.8+/-19.1 U/L, p<0.001)--whereas in the OC group, 24 hours after the procedure, the serum value of ALT and AST was above the upper normal limits in only in one patient. A further increase in serum ALT and AST value was observed in the LC group (ALTLC72: 99.3+/-19.5 U/L, p<0.001; ASTLC72H: 103.5+/-21.6 U/L, p<0.001) 72 hours after the operation. The mean value of ALT and AST in the OC group was within normal limits 72 hours after the procedure. Slow return to normality occurred 7-10 days after the procedure in the LC group. CONCLUSION: Alterations in hepatic function occur after laparoscopic cholecystectomy and appear to be clinically insignificant. CO2 pneumoperitoneum seems to be the main reason for theses changes but other factors may also contribute. We also measured the values of ALP, GGT, INR and bilirubin. No statistically significant increase was noticed in any groups between the preoperative and postoperative values of these enzymes.

Adult↗
PubMed2005

Suture material as a nidus for common bile duct stones: taking a closer look.

A 72-year-old female with recurrent biliary colic and abnormal liver function 27 years after open cholecystectomy, was investigated by abdominal ultrasound, magnetic resonance pancreatocholangiogram (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). The ultrasound scan demonstrated a polypoid filling defect in the common bile duct (confirmed at ERCP), thus raising the possibility of a common bile duct tumour. The MRCP was normal. Visual examination of the duct with a choledochoscope revealed two stones attached to the wall by black suture material. The role of suture material in the formation of common bile duct stones, and direct choledochoscopy, is reviewed.

Aged↗
PubMed2005

Malignant fibrous histiocytoma of the liver: a case report and review of the literature.

Malignant fibrous histiocytoma (MFH) is a common soft tissue sarcoma, usually occurring in the extremities. MFH of the liver is an extremely rare neoplasm, with only 28 cases reported in the international literature since 1985. We present a case of MFH of the liver in an 87-year-old woman. The tumor was located in the right lobe of the liver and measured 12 ' 8 cm. It consisted of spindle-shaped, pleomorphic, malignant cells in a storiform pattern associated with histiocyte-like cells and giant cells. Most of the tumor cells and giant cells were vimentin and a 1-antichymotrypsin positive. Histopathological findings were consistent with an MFH of the storiform / pleomorphic subtype. The literature is briefly reviewed.

Aged↗
PubMed2005

Septic shock; current pathogenetic concepts from a clinical perspective.

Sepsis is an infection-induced syndrome characterized by a generalized inflammatory state and represents a frequent complication in the surgical patient. The normal reaction to infection involves a series of complex immunologic processes. A potent, complex immunologic cascade ensures a prompt protective response to microbial invasion in humans. Although activation of the immune system during microbial invasion is generally protective, septic shock develops in a number of patients as a consequence of excessive or poorly regulated immune response to the offending organism (Gram-negative or Gram-positive bacteria, fungi, viruses, or microbial toxins). This unbalanced reaction may harm the host through a maladaptive release of endogenously generated inflammatory compounds. Many mechanisms are involved in the pathogenesis of septic shock, including the release of cytokines, the activation of neutrophils, monocytes, and microvascular endothelial cells, as well as the activation of neuroendocrine reflexes and plasma protein cascade systems, such as the complement system, the intrinsic (contact system) and extrinsic pathways of coagulation, and the fibrinolytic system. In critically ill patients, the gastrointestinal tract plays a central role in the pathogenesis of septic shock. The potential for complementary and synergistic interaction of the different components in this cascade highlights the difficulty encountered in trying to identify a single means of altering the progression of sepsis and septic shock to multiple organ dysfunction syndrome (MODS) and multiple organ failure (MOF).

Blood Coagulation Disorders↗
PubMed1999

ACTH-Producing Cholangiocarcinoma Associated with Cushing's Syndrome.

A 61-year~old woman was admitted to the hospital with clinical manifestations of Cushing's syndrome. The ACTH level was 1340 pglmL, the urinary free cortisol level > 900 pg/mL, and the serum K+ levels 21 meqlL. The brain/pituitary MRI and thoracic CT scan were normal. Gastroscopy, colonoscopy, and small bowel follow through were normal. Abdominal CT and MRI showed normal adrenals, but dilated gallbladder with numerous gallstones, as well as peripancreatic and hepatoduodenal lymphadenopathy. A large meta-static deposit and three smaller lesions were also seen in the liver. Because of the poor respiratory function tests and the severe hypokalaemia, laparoscopy under local anaesthesia was performed. Following the procedure the patient became gradually jaundiced and thus underwent exploratory laparotomy. Locally advanced cholangiocarcinoma was found, infiltrating the liver hilum, with multiple small bilateral liver metastatic deposits. Acute cholecystitis with pericholecystic abscess was also found. Cholecystostomy as well as gallbladder, liver and hilar node biopsies were performed. Histopathology showed liver adenocarcinoma of bile duct origin, while immunocytochemistry revealed scattered, chromogranin A positive cells, some of them strongly immunoreactive for ACTH. Small clusters of chromogranin A positive cells were also found to be immunoreactive for CRH, but not for ACTH.

Journal Article↗
PubMedDate not supplied

Surgical management of chronic pancreatitis: current concepts and future perspectives.

Initial management of chronic pancreatitis is always conservative. All forms of nonsurgical intervention should be exhausted before surgery. Main indications for surgery in chronic pancreatitis are intractable pain, suspicion of malignancy, and complications from adjacent organs. Preoperative evaluation should include an evaluation of the severity of pain, interference of quality of life, and presence of chemical dependency and imaging examinations to determine the primary site of disease, presence of pancreatic ductal dilatation, and associated peripancreatic complications. The surgical treatment approach involves proximal or distal resection (depending on the main location of the disease) for small-duct disease and lateral pancreaticojejunal drainage for large-duct disease. The newer duodenum-preserving head resections of Beger and Frey and thoracoscopic transthoracic splanchnicectomy await good confirmatory, independent trials to confirm their efficiency in the surgical management of chronic pancreatitis. The V-shaped excision of ventral pancreas in association with a lateral pancreatojejunostomy is also an interesting alternative in the management of small-duct disease that is also under investigation. In recent years, a clear trend in favor of resectional procedures (including the newer nonanatomic pancreatic resections) has been observed.

Chronic Disease↗