PubMed Health⌕ Search

Biomedical subjects

I Kanellos

Publications and source records attributed to I Kanellos.

At least 37 records · Page 2Linked to original sources
PubMed2004

Repair of parastomal hernia with the use of polypropylene mesh extraperitoneally.

Parastomal hernia is the most frequent complication of colostomy. Many surgical techniques have been postulated and prosthetic surgery seems to represents the first-choice treatment. The aim of this study is to report the surgical treatment of 4 patients that developed parastomal hernia, 3-10 months after abdominoperineal excision of the rectum and permanent sigmoidostomy due to carcinoma of the rectum. The repair was made with the use of polypropylene mesh extraperitoneally. One case of limited skin necrosis occurred without any serious consequences. No recurrence has been recorded among the patients, up to this day (follow-up period: 36 months). In conclusion, the suturing of fascial defect and the use of polypropylene mesh extraperitoneally is effective in the treatment of parastomal hernia.

Adult↗
PubMed2004

Survival after curative resection for rectal cancer by the end of the 20th century.

BACKGROUND: The aim of this study was to define the survival rates in patients with rectal carcinoma treated with curative resections. PATIENTS AND METHODS: Between 1993 and 1998, 54 patients with rectal cancer underwent curative resection by conventional technique. Tumour location, TNM staging and tumour differentiation were evaluated. Among the 54 patients, 14 underwent high anterior resection, 28 low anterior resection, 7 abdominoperineal resection and 5 underwent local excision. Survival rates were calculated using the Kaplan-Meier method and long-range analysis. RESULTS: Five-year survival was 70.4%. The survival rate statistically significantly decreased with increasing TNM tumour stage (p=0.009). Patients with poor differentiation of the tumour had the lowest 5-year survival (33%) compared to patients with moderate (72%) and good (78%) tumour differentiation. Sex and age did not affect survival. Location of the tumour in the distal end of the rectum and mucinous characteristics are poor prognostic factors affecting survival. CONCLUSIONS: Curative resection combined with chemoradiotherapy, whenever necessary, is accompanied with acceptable 5-year survival rates.

Adult↗
PubMed2004

Effects of steroid on the healing of colonic anastomoses in the rat.

BACKGROUND: The aim of this experimental study was to evaluate the effects of steroid on colonic anastomosis in a rat model. METHODS: Forty female Wistar rats were randomised into two groups. After resection of a 1-cm segment of the transverse colon, an end-to-end sutured anastomosis was performed. In the rats of the control group 2 ml of solution 0.9% NaCl was injected once daily intraperitoneally perioperatively. Rats of the steroid group received intraperitoneally once daily, and on the same perioperative days, hydrocortisone (5 mg/kg body weight in 2 ml solution NaCl). All the rats were sacrificed on the 8th postoperative day and the anastomoses were examined macroscopically. The bursting pressure measurements were recorded and anastomoses were graded histologically. RESULTS: Dehiscence rate was significantly higher in the steroid group than in the control group (p<0.001). Mean bursting pressure was significantly lower in the steroid group compared to the control group (p<0.001). Colonic healing process assessed as inflammatory cell infiltration and collagen deposition was significantly lower in the steroid group than in the control group (p<0.001, p=0.03 respectively). CONCLUSIONS: Perioperative steroid treatment adversely affects healing of colonic anastomoses in the rat.

Anastomosis, Surgical↗
PubMed2003

Effects of the use of fibrin glue around the colonic anastomosis of the rat.

BACKGROUND: This study was aimed at examining whether the addition of fibrin glue to a sutured colonic anastomosis improves its healing or not. METHODS: We studied the effect of adding fibrin glue on a sutured colonic anastomosis. Thirty-six Wistar rats were randomized into two groups of 18 rats each. A sutured anastomosis was performed in all rats. Fibrin glue was applied around the anastomosis of the rats of group B. Rats were sacrificed on the eighth postoperative day. RESULTS: The rate of anastomotic leakage was found not to be significantly different between the two groups. The mean bursting pressure of the colonic anastomoses was significantly higher in group B (fibrin-treated) than in group A. CONCLUSION: Fibrin glue application around a sutured anastomosis provides a safer anastomosis which is stronger than the sutured one.

Anastomosis, Surgical↗
PubMed2003

Incidence and prognostic value of positive peritoneal cytology in colorectal cancer.

PURPOSE: This study was conducted to investigate the incidence of free cancer cells in the peritoneal washings of patients who had undergone surgery for colorectal cancer and to evaluate its influence as a prognostic factor of the disease. METHODS: From 1990 to 1996, intraoperative washing cytology was performed in 110 patients who underwent surgery for colorectal cancer. All patients had curative resections. Immediately after the abdomen was opened and before exploration and mobilization of the tumor, 100 ml of saline was injected over the tumor site. Washings were then aspirated and taken for cytologic examination. RESULTS: Twenty-two (20 percent) of 110 patients examined were found to have positive cytology for intraperitoneal free malignant cells. The site of tumor in the colon or rectum, tumor size, nodal status, degree of differentiation, mucinous characteristics, and vascular or neural invasion were found not to affect the incidence of free cancer cells. Conversely, tumor penetration was found to affect the incidence of positive cytology. The degree of association among the stages of tumor penetration was indicated by the contingency coefficient, which was 0.42. Patients with positive cytology had a significantly higher rate of local recurrence and peritoneal carcinomatosis (22.8 vs. 8 percent, P = 0.05) than patients with negative cytology. Mortality rate was not found to be related to the presence of free cancer cells. CONCLUSION: Cytologic examination of peritoneal lavage at the time of surgery could be a useful prognostic indicator for local and peritoneal recurrence rate. However, it was not found to be a predictor of survival.

Adenocarcinoma↗
PubMed2003

A comparison of the simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately, for the treatment of haemorrhoids: a prospective randomized trial.

OBJECTIVE: To compare simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately for the treatment of 2nd degree haemorrhoids. PATIENTS AND METHODS: Between 1993 and 1996, 255 patients that suffered from 2nd degree haemorrhoids were divided into 3 groups of 85 patients, each to receive either simultaneous sclerotherapy for smaller and rubber band ligation for larger piles (SCL/RBL) in one session, or sclerotherapy (SCL), or rubber band ligation (RBL), respectively. After a period of 4 years all patients were examined and their symptoms were recorded. RESULTS: The patients of the SCL group developed significantly fewer complications after treatment compared to the other two methods (P < 0.001), which did not differ from each other. After the SCL/RBL treatment, significantly more patients were symptom free (46%) than after SCL (8%), P < 0.001. There was no significant difference between the SCL/RBL (46%) and the RBL (31%) groups (P = 0.217), although the combined treatment seemed to be more effective than rubber band ligation. Only 10% of the patients of the SCL/RBL group needed additional sessions 6-24 months after the initial treatment compared to 30% of the patients of the SCL group (P = 0.001). However, there was no significant difference between SCL/RBL and RBL (17%) groups (P = 0.151). CONCLUSION: The combination of sclerotherapy and rubber band ligation for treatment of 2nd degree haemorrhoids is significantly more efficient than sclerotherapy on its own.

Combined Modality Therapy↗
PubMed2002

The endoscopic management of persistent bile leakage after laparoscopic cholecystectomy.

BACKGROUND: Bile leakage after laparoscopic biliary surgery is a surgical challenge in which endoscopy can play an important role. METHODS: A total of 26 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) in our department. Patients with evidence of major ductal injury were treated surgically. In all other cases, endoscopic sphincterotomy was performed, any retained bile duct stones were removed, and a biliary endoprosthesis or a nasobiliary catheter was inserted on a selective basis. RESULTS: ERCP was successful in 24 patients. Seven patients were treated surgically after cholangiography revealed major ductal injury. Two more patients were eventually operated on due to bile peritonitis. Of the other 15 patients, 11 had leakage from the cystic duct and four had leakage from the gallbladder bed. Bile duct stones were removed from eight patients, an endoprosthesis were inserted in five patients, and a nasobiliary catheter was inserted in two patients. Bile leakage was treated successfully in all 15 patients with no further complications. CONCLUSION: ERCP is a means of safe diagnosing the cause of a bile leakage and offers a definitive treatment in most cases.

Bile↗
PubMed2002

Sutureless colonic anastomosis in the rat: a randomized controlled study.

The aim of the present study was to evaluate the effect of glue tissue on the healing of colonic anastomosis in rats. Two groups of 20 Wistar rats each were used. Following laparotomy, a segment of 1 cm of the colon was resected, 10 cm from the ileocecal valve. In the control group, the anastomosis was sutured in a single layer with 6-0 polypropylene interrupted extramucosal sutures. In the glue group, the anastomosis was performed by using 2-octyl cyanoacrylate (Dermabond, Ethicon). Rats were sacrificed on day 7 following operation. Integrity of the anastomoses, existence of perianastomotic abscess or peritonitis, and adhesion formation were recorded. Anastomoses were resected including a 2.5-cm of bowel on either side. Bursting pressures were measured and the specimens were sent for histological examination. Anastomotic dehiscence occured in 20% of the animals in each group. Adhesion formation was more extensive in the glue group compared to the control group, but this difference was not statistically significant (p=0.074). Bursting pressures of the anastomoses between the two groups were not statistically significant (p=0.897). The wound healing process, as assessed by inflammatory cell infiltration, blood vessel neodevelopment, collagen deposition and fibroblast activity, did not differ statistically between the two groups (p>0.05). In conclusion, 2-octyl cyanoacrylate provides, under experimental conditions, a sutureless anastomosis equal in healing to the conventionally sutured one. The outcome may differ under demanding clinical situations.

Anastomosis, Surgical↗
PubMed2002

Low anterior resection without defunctioning stoma.

The aim of our study was to determine the anastomotic leakage rate after the performance of low anterior resection without protective stoma. During the time period from 1989 to 2001, 82 consecutive patients underwent low anterior resection for rectal carcinoma without protective stoma. Thirteen anastomoses were hand sewn (15.8%) and the remaining 69 (84.2%) were constructed with the use of a circular stapling gun. The mean distance of the anastomoses from the anal margin was 6.2 cm (range, 3-9 cm). None of the 82 low anterior resections was covered by a defunctioning stoma. Clinical anastomotic leakage occurred in 4 patients (4.9%) and 4 other patients presented radiologically detected leakage (4.9%). No death occurred in the 8 patients that presented anastomotic dehiscence. Non-specific complications were detected in 11 (13.4%) of 82 patients. In conclusion, the low leakage rate of the anastomoses in our patients allows us to recommend low anterior resection without defunctioning stoma.

Adult↗
PubMed2002

Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors.

BACKGROUND AND STUDY AIMS: Previous studies on the development of post-endoscopic retrograde cholangiopancreatography (post-ERCP) hyperamylasemia and pancreatitis have focused on different risk factors, either procedure- or patient-related, and also prognostic factors, such as amylase levels together with the occurrence of pancreatic-type pain, which might be implicated. The aim of this study is to identify possible predictive risk factors and also prognostic factors in order to better organize the treatment strategy. PATIENTS AND METHODS: During a 5-year period, 556 ERCP procedures were performed by the same operator. Of these, 43 procedures were excluded from the study. Data recorded from the procedures included both patient characteristics and procedure details. Patients were evaluated for pancreatic-type pain at 4 and 24 h after the procedure, and serum amylase levels were determined at 2 and 24 h after the procedure. Pancreatitis was diagnosed on the basis of both clinical and laboratory examination, while patients with hyperamylasemia were in a normal clinical condition but had high serum amylase levels. RESULTS: Post-ERCP pancreatitis occurred after 17 procedures (3.3%) and hyperamylasemia after 85 procedures (16.5%). Patients who developed pancreatitis all had pancreatic-type pain together with amylase levels higher than 4-5 times the upper normal limit at 24 h after ERCP. There was a significant association between serum amylase levels and post-procedure pancreatic-type pain both at 4 h and 24 h after ERCP (P = 0.006). Age less than 50 years, history of relapsing pancreatitis, pancreatic duct opacification, and difficulty in obtaining bile duct cannulation all proved to be significant predictive risk factors for the development of either hyperamylasemia or pancreatitis. In contrast, additional procedures and sphincterotomy seemed to reduce the likelihood of both complications. CONCLUSIONS: Serum amylase levels higher than 4 - 5 times the normal upper limit together with the existence of pancreatic-type pain, at 24 h after ERCP, strongly suggest the occurrence of pancreatitis. When any of the predictive risk factors coexist during a procedure it would be better either to abandon the procedure and try again later or, if the situation is urgent, to have earlier recourse to an alternative, such as precut or needle-knife papillotomy.

Adolescent↗
PubMed2002

Stapled haemorrhoidectomy compared with Milligan-Morgan excision for the treatment of prolapsing haemorrhoids: a prospective study.

OBJECTIVE: To compare stapled haemorrhoidectomy with Milligan-Morgan haemorrhoidectomy. DESIGN: Prospective open study. SETTING: Teaching hospital, Greece. PATIENTS: 85 patients with prolapsing haemorrhoids were invited to choose between stapled and Milligan-Morgan haemorrhoidectomy. 48 chose the former and 37 the latter. INTERVENTIONS: Operation. Postoperatively, the patients were given analgesics on demand, and were discharged as soon as their condition and particularly their pain had improved. MAIN OUTCOME MEASURES: Patients' symptoms and their opinion about the procedures, which were recorded during their follow-up which lasted for 6 months. RESULTS: Stapling resulted in a significantly shorter operating time, and less postoperative pain and other symptoms, than Milligan-Morgan excision (p < 0.001). Postoperative complications, and mean time in hospital did not differ significantly between the two groups. During the follow-up period there was no significant difference in the incidence of recurrences between the two groups. Six months after the operation, significantly more patients in the stapled group had residual skin tags-external haemorrhoids than in the Milligan-Morgan group, and all these patients had fourth degree haemorrhoids. CONCLUSIONS: Stapled haemorrhoidectomy is a promising method of treatment for prolapsing third degree haemorrhoids. Its effectiveness is questionable for fourth degree ones. Initially, the results are as good as after Milligan-Morgan haemorrhoidectomy, especially for third degree haemorrhoids. However, more patients and longer follow-up periods are required for its long-term efficacy to be confirmed.

Adult↗
PubMed2001

Perineal endometriosis in episiotomy scar with anal sphincter involvement.

Perineal endometriosis, especially with anal sphincter invasion, is a rare occurrence. We present a patient with perineal endometriosis in an episiotomy scar with anal sphincter involvement. The endometriotic mass was completely excised under general anesthesia with portions of the episiotomy scar and external anal sphincter. The procedure was followed by overlapping sphincter reconstruction. The excised mass was sent for microscopic examination, which confirmed endometriosis. The postoperative course was without complications. One year after the operation, the woman is asymptomatic and fully continent. Complete excision including a part of the anal sphincter with primary sphincteroplasty is the best treatment for perineal endometriosis involving the anal sphincter.

Adult↗
PubMed2000

Long-term evaluation of sclerotherapy for haemorrhoids. A prospective study.

BACKGROUND: Sclerotherapy is one of the older methods of conservative treatment of haemorrhoids. It has been widely used and the early results are considered satisfactory although the long-term results are not as good as expected. AIMS: The evaluation of long-term results of sclerotherapy in patients with symptomatic 1st and 2nd degree haemorrhoids. METHODS: From 1990 until 1996, 240 outpatients, 154 men and 86 women, with symptomatic 1st and 2nd degree haemorrhoids, underwent sclerotherapy. The most common symptoms were bleeding for patients with 1st degree haemorrhoids and prolapse for patients with 2nd degree. After 3 years all patients were called and examined and their symptoms were recorded. 38 patients were excluded. RESULTS: 3 years after sclerotherapy 20 patients (20.2%) with 1st degree haemorrhoids and 9 patients (8.7%) with 2nd degree were symptoms free. 42 patients (42.4%) with 1st degree haemorrhoids and 66 patients (64.1%) with 2nd degree were worse, and the remainder were either improved or unchanged. Bleeding and prolapse were the most frequent recurrent symptoms. CONCLUSION: The frequency of recurrent symptoms 3 years after sclerotherapy for symptomatic 1st and 2nd degree haemorrhoids is high. Sclerotherapy appears to be an inappropriate method of treatment for symptomatic 1st and especially 2nd degree haemorrhoids.

Female↗
PubMed1998

Effect of early versus delayed postoperative injection of 5-fluorouracil plus interferon-alpha on colonic healing.

The purpose of this study was to determine whether delayed, postoperative, intraperitoneal treatment with 5-fluorouracil (5-FU) plus interferon-alpha-2a (IFN) has adverse effects on colonic healing, as does early treatment. Seventy male Wistar rats underwent colonic anastomoses. The rats were randomized to one of four groups. Early intraperitoneal injection was given to groups 1 and 2 which was repeated once daily for the first 3 postoperative days. Treatment was delayed in groups 3 and 4, from the 4th to the 7th postoperative day. A 0.9% NaCl solution was injected in the rats of control groups 1 and 3. In groups 2 and 4, we infused 5-FU (20 mg/kg/day) and IFN (45,000 IU/kg/day). All the animals were sacrificed on the 8th postoperative day. The anastomotic rupture rate was significantly higher in the rats of group 2 compared to control group 1 (p < 0.05), while there were no differences between groups 3 and 4 (p > 0.05). Abscess formation and adhesions were more frequent in group 2 compared to control group 1, while no differences were observed between groups 3 and 4. Anastomotic bursting pressure was statistically significantly lower in the rats of group 2 compared to group 1 (p < 0.05); no differences were noticed between groups 3 and 4 (p > 0.05). Simultaneous histologic evaluation showed a more profound inflammatory reaction and delayed anastomotic healing in group 2 compared to control group 1; there were, however, no differences between groups 3 and 4. In conclusion, the immediate, postoperative, intraperitoneal injection of 5-FU plus IFN impairs colonic healing while delayed treatment (starting on the 4th postoperative day) has no adverse effects on wound healing.

Anastomosis, Surgical↗
PubMed1997

Colonic healing after early intraperitoneal administration of 5-fluorouracil and interferon in rats.

The aim of this experimental study was to investigate whether the intraperitoneal perioperative injection of 5-flurouracil (5-FU)--with or without the addition of interferon (INT)--influences colonic healing. We used 57 male Wistar rats which were subjected to anastomosis of the colon. Intraoperatively, the rats were randomised into one of three groups. The rats in the control group (group 1, n = 15) received a 0.9% NaCl solution; the rats in group 2 (n = 21), 5-FU (20 mg/Kg/day), and those in group 3 (n = 21), 5-FU (20 mg/Kg/day) plus INT (45,000 IU/Kg/day). These drugs were injected intraperitoneally during the operation and once daily for the next two days. The rats were sacrificed on post-operative days 3, 5 or 8. The rupture rate of the anastomoses was statistically significantly higher in groups 2 and 3, compared with the control group (P < 0.05); no differences were observed between groups 2 and 3. Abscess and adhesion formation were more marked in groups 2 and 3 than in the control group; however no differences were recorded between groups 2 and 3. The anastomotic bursting pressure was statistically significantly lower in groups 2 and 3 compared to the control group (P < 0.05), on post-operative days 5 and 8; however, no differences were measured between groups 2 and 3. Histologic evaluation also showed a more profound inflammatory response in groups 2 and 3, compared with group 1. In conclusion, the intraperitoneal, intraoperative administration of 5-FU hinders colonic healing in rats. The additional intraperitoneal injection of interferon does not seem to aggravate this adverse effect.

Anastomosis, Surgical↗