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J Androulakis

Publications and source records attributed to J Androulakis.

At least 19 recordsLinked to original sources
PubMed1996

Evaluation of the effects of autotransfusion of unprocessed blood on hemodynamics and oxygen transport in anesthetized pigs.

OBJECTIVE: To examine the hemodynamic effects and the oxygen transport pattern of autotransfusion of unprocessed blood on hemodynamics and oxygen transportation. DESIGN: Prospective, observational study. SETTING: Research laboratory of a university medical center. SUBJECTS: Six healthy, domestic pigs (20 - 33 kg). INTERVENTIONS: A left thoracotomy was performed and a 5-mm incision was created in the descending aorta, resulting in a controlled hemorrhage of 30 mL/kg (approximately 40% of blood volume) into the thoracic cavity over a 45-min time period. During that period, mean arterial pressure (MAP) was maintained slightly > 50 mm Hg, using intravenous lactated Ringers' solution. The blood sample was collected from the open thorax with compresses soaked in citric acid solution and then extracted by manual squeezing, filtered through several layers of gauzes, and stored in glass bottles. Repeat measurements were performed after hemorrhage, after retransfusion of the harvested blood, and thereafter every 15 mins up to 60 mins. The animals were supported for 2 more hrs and were observed for the following 48 hrs. MEASUREMENTS AND MAIN RESULTS: All animals survived and were in good condition 48 hrs after the experimental hemorrhage. The circulatory and oxygen transport response at the end of hemorrhage and concomitant maintenance of blood pressure at > 50 mm Hg resulted in: significant reductions of cardiac index, MAP, and oxygen transport (DO2) (46%, 50%, and 64% reductions, respectively, p < .01, in an increase of heart rate (HR) (+21%, not significant), pulmonary vascular resistance index (+112%, p < .05), and oxygen extraction (+105%, p < .01), as well as in a nonsignificant decrease of systemic vascular resistance index (-8%). After autotransfusion, the basic hemodynamic variables, MAP and HR were corrected, remaining near baseline (not significant) afterward. Cardiac index and DO2 increased after autotransfusion, but remained below the baseline until the end of the study protocol (p < .05). A significant increase was noticed for pulmonary arterial pressure and pulmonary vascular resistance index immediately after autotransfusion (p < .01). These values were corrected in part after 15 to 30 mins, but remained higher throughout the observaton period compared with baseline (29.5% and 89.8%, respectively, p < .05). The recently introduced relationship between cardiac index and oxygen extraction has been proposed to avoid problems of mathematical coupling between oxygen consumption and DO2 measurements. This relationship followed a similar course in all experiments throughout each phase. A shift downward and to the right represented the endpoint of the hemorrhagic phase. After autotransfusion, a shift toward baseline was noticed. Prothrombin time and partial thromboplastin time remained unchanged after autotransfusion. Free hemoglobin concentrations increased immediately after autotransfusion (+33%, p < .05), but returned to baseline values 48 hrs later. Histologic examination showed no changes in the examined organs. CONCLUSIONS: Reinfusion of large amounts of unprocessed blood (up to 40% of blood volume), collected with compresses from a noncontaminated surgical field is a cheap method, which may be of potential benefit in trauma patients, when more sophisticated autotransfusion devices are lacking. In the present study, this method resulted in transient but significant hemodynamic changes in the pulmonary circulation. Impairment of oxygen transport was noticed after the end of hemorrhage, but this impairment cannot be attributed to the autotransfusion technique alone, but also to factors such as hemorrhagic shock, surgical trauma, etc.

Animals↗
PubMed1995

Using the hypertext software to develop computer-assisted instruction in oncology for medical students.

A new development in computer-assisted medical education has been the introduction of hypertext authoring systems. Authoring systems are computer programs that can allow an instructor to prepare computer-based medical educational materials without the need to know programming languages. Hypertext is a database management system that lets the user connect screens of information using associative links. The authors developed a hypertext authoring system for teaching their medical students the domain of oncology. The features of the system are hierarchical structure, index browsing, and nonsequential browsing. Moreover, the student may become a writer of a hyperdocument by typing a few script commands. In this way the hierarchical structure of a document meets the needs of the reader. Although hypertext brings with it a few difficulties for the student, the authors expect that the system will become a popular mean for organizing textual information for retrieval and browsing in oncology.

Computer-Assisted Instruction↗
PubMed1994

Solitary hepatic lymphangioma. A rare benign tumour: a case report.

Hepatic lymphangiomas are extremely rare; moreover cystic lymphangiomas usually arise in areas such as the neck and axilla, where loose connective tissue allows the expansion of lymphatic channels. The case of a 65-year old male is described, who presented with a solitary lymphangioma in the liver. The lesion was discovered incidentally and due to diagnostic uncertainty was removed surgically. A short review of histology, clinical presentation and preoperative diagnostic difficulties of hepatic lymphangiomas is given.

Cholecystectomy↗
PubMed1993

Treatment of fistulas of the gastrointestinal tract with total parenteral nutrition and octreotide in patients with carcinoma.

The development of a fistula is a serious postoperative complication. Conservative medical treatment with total parenteral nutrition, skin care and intensive infection control usually succeeds in closing fistulas (60 to 75 percent), but the treatment is of long duration (two to three months), high cost and high morbidity related to prolonged hospitalization. We have used octreotide, a long half-life stomatostatin analog, in 40 patients from two European university centers with postoperative enterocutaneous fistulas. Twenty-two patients had low fistula output and 28 patients had high fistula output. Spontaneous closure was achieved in 77.5 percent of the patients after a mean of 13.6 days. One patient died. Glucose intolerance, which has been reported with stomatostatin treatment of fistulas, was not observed. Previous chemotherapy or radiotherapy or low albumin level (23 grams per deciliter) negatively influenced fistula closure. As an adjunct treatment to primary care (total parenteral nutrition, skin care and infection control), octreotide is efficient in reducing fistula output and accelerating spontaneous fistulas closure.

Adult↗
PubMed1992

Major vascular lesions associated with orthopaedic injuries.

Seventeen patients, aged 11-67 years (mean, 32.6), with major vascular injuries associated with traumatic orthopaedic injuries, were treated operatively in the authors' institution over a 4-year period. The most common mechanism of trauma was a high-energy injury (70.8%), and the rate of open injuries was 88.2%; 64.9% of the injuries were located in the lower extremities. The treatment protocol consisted of aggressive resuscitation; Doppler imaging and, when necessary, angiography; stable bone fixation with subsequent vascular repair; and extended wound debridement. The vascular repair for arterial lacerations consisted of (a) end-to-end anastomosis (47.2%); (b) interpositional homologous vein graft (23.6%); (c) vascular decompression through fracture distraction in one patient (5.9%); (d) xenograft interposition (in one patient; 5.9%); (e) venous repair (in three patients; 17.7%); and (f) embolectomy (in all patients). Three vascular reoperations (17.7%) were necessary because of rupture of the anastomosis. The authors' preferred bone stabilization method was external fixation, which was used in 47.2% of cases. Amputation was performed in three cases (17.7%) as a salvage operation. Although six patients (35.4%) were admitted with delayed shock (mean duration, 73.6 +/- 27.8 min), this led to a lethal outcome due to shock lung in only one patient. Another patient developed massive lung embolism 3 months postoperatively and died. The authors believe that this well-organized approach, based on a specific treatment protocol, for patients with severe orthopaedic trauma and concomitant vascular injury, not only improves outcome but gives good to excellent functional results in the majority of patients.

Adolescent↗
PubMed1992

Successful treatment of postoperative external biliary fistula by selective nasobiliary drainage.

A 25-year old man presented with a high output external biliary fistula after an operation for a giant hydatid cyst of the liver. Endoscopic sphincterotomy was inadequate to close the fistula. A nasobiliary tube was selectively inserted into the leaking hepatic duct and bile was continuously aspirated. The fistula and the residual cavity healed completely. Details of the patients' management using this alternative technique, are discussed.

Adult↗
PubMed1992

Smooth muscle tumors of the gastrointestinal tract. A 10-year experience.

Benign or malignant smooth muscle tumors of the gastrointestinal tract are uncommon. The diagnostic and therapeutic approaches vary depending on the histological behavior of these neoplasms. Between 1981 and 1991, 32 patients with gastrointestinal tumors were treated at the Department of Surgery of the University of Patras. There were 16 females and 16 males. The mean age at the time of diagnosis was 61.9 years (range 22-83 years). Eighty-one per cent of the tumors were discovered in asymptomatic patients by a variety of diagnostic studies. Fifty-six per cent of tumors were located in the stomach, 38% in the small intestine and 6% in the colon. Leiomyomas made up 71.8% of these tumors and were treated by conservative excision. The malignant smooth muscle tumors were treated by radical excision in four cases and conservative excision in one case. The 5-year survival rate was 85% for leiomyomas and 0% for malignant smooth muscle tumors. There is widespread agreement that wide resection of the lesion is the appropriate treatment for these tumors. The size and mitotic activity of these tumors remain the most important diagnostic parameters and prognostic factors.

Adult↗
PubMed1992

Improved techniques in the surgical treatment of hepatic hydatidosis.

We evaluated 64 patients with hepatic hydatidosis who were treated during 1982 to 1988. The main clinical manifestations were epigastric pain (84 per cent), hepatomegaly (31 per cent), fever (30 per cent) and jaundice (25 per cent). Five patients were asymptomatic. All diagnoses were established by ultrasonography and computed tomography, or both (sensitivity rates of 95 and 93 per cent, respectively). Treatment was exclusively surgical and there were no deaths. In the five patients in group 1, total cystectomy was done without morbidity. The 19 patients in group 2 underwent a limited capsectomy, evacuation of the cyst, omentoplasty, suturing of the biliary communications and drainage of the residual cavity, with a rate of morbidity of 42 per cent. In the 40 patients in group 3, a wide capsectomy and unroofing of the cyst were done, the contents were removed, the cavity edges were hemostatically oversewn and the residual hepatic cavity was drained through a high vacuum, closed drainage system. Omentoplasty was not routinely done. With this technique, the rate of morbidity was reduced to 2.5 per cent. Of 64 patients, 32 were observed for an average of 42 months with a recurrence rate of 9 per cent. Because of the low rate of postoperative morbidity, recurrence and the shorter period of hospitalization, the surgical technique used in group 3 seems to be an efficient method for hepatic hydatidosis.

Adolescent↗
PubMed1991

Sources of diagnostic discrepancies in fine-needle aspiration of the breast.

Fine-needle aspiration (FNA) is a valuable technique to use in the evaluation of breast lesions; however, inadequate and discrepant diagnoses do occur. To identify the source and nature of inaccuracies related to the method we studied 39 cases in which FNA posed diagnostic problems. These problems could be attributed to sampling errors (71.8%), to the criteria of adequacy we use at our institution (25.6%), and to interpretation (2.6%). The nature of the breast lesion (68%) was the most common cause of inadequate sampling, followed by the experience of the aspirator (32%).

Biopsy, Needle↗
PubMed1991

Diagnosis of thyroid cancer in southwestern Greece.

A prospective study of 1,200 patients with thyroid disease was performed from 1983 to 1988 to appraise the reliability of various diagnostic techniques in patients with thyroid cancer. Histologic confirmation was obtained in 201 patients. By assuming that only solid lesions, single or multiple, represented malignancy, the sensitivity and specificity of ultrasonography was 4.64 and 52.2%, respectively. Findings of fine needle aspiration (FNA) cytology and of carcinoembryonic antigen (CEA) serum concentration were also evaluated. The sensitivity and specificity of these two methods (91.2% and 84.1% for FNA and 89.7% and 81.3% for CEA, respectively) were found to be high enough to permit surgical intervention after a diagnosis of malignancy was made. It appears that the combination of FNA cytology and CEA serum measurement represents the most accurate method for the pre-operative detection of thyroid cancer.

Biopsy, Needle↗
PubMed1991

Complications of splenic tissue reimplantation.

Splenic tissue reimplantation employing the omental implantation technique was applied in 23 patients undergoing splenectomy for traumatic or iatrogenic splenic injury. Four complications were encountered after autotransplantation (17.4%). Two of these consisted of small bowel obstruction due to postoperative adhesions and were successfully managed by lysis of the adhesions. The other two complications were aseptic necrosis of the splenic transplants and were treated with ablation of the autolysed transplants. A case of abnormal splenic tissue reimplantation in a male patient with unsuspected myelofibrosis is also discussed. He underwent an emergency laparotomy for rupture of a subcapsular splenic haematoma. It is concluded that splenic tissue implantation in the greater omentum is associated with important early morbidity and this should be taken into account whenever application of the method is considered.

Adolescent↗
PubMed1991

Radical consequence in the sexuality of male patients operated for colorectal carcinoma.

Sixty sexually-active male patients affected by colorectal cancer and surgically treated at the Department of Surgery at University of Patras between 1981 and 1987 were interviewed by structured questionnaire to evaluate the etiology of sexual dysfunction. Patients were divided into three groups: (1) 20 patients, mean age 60.5 years (range 39-70), subjected to high anterior resection for carcinoma of the sigmoid colon (not lower than 18 cm from the anal margins, 1.2% Dukes' A, 31% Dukes' B, 67.8% Dukes' C); (2) 20 patients, mean age 62.4 years (range 43-70), subjected to low anterior resection (not more than 8 cm from the anal margins, 3% Dukes' A, 36% Dukes' B, 61% Dukes' C); and (3) 20 patients, mean age 59.75 years (range 27-70), subjected to abdominoperineal surgery (Miles' technique) in whom the malignancy was in the distal rectum (8% Dukes' A, 32% Dukes' B, 60% Dukes' C). The first group served as the control. All the anastomoses in the low anterior resection group were performed by manual suture. Statistical evaluation of the three groups was by the chi 2-test. The form of sexual dysfunction, (1) cessation of sexual relationship, (2) absence of erection, (3) impossible penetration or (4) absence of ejaculation, varied according to the type of operation, the frequency of each form being 5%, 5%, 30%, 20% for the high anterior resection, 65%, 45%, 60%, 50% for Miles' operation and 20%, 25%, 45%, 5% for the low anterior resection respectively.

Adult↗
PubMed1988

Total parenteral nutrition by intraperitoneal feeding in rabbits.

The possibility of intraperitoneal (IP) parenteral nutrition was suggested after the observation that glucose and amino acids pass from the peritoneal cavity into the systemic circulation. We used rabbits to study the characteristics of the transfer of glucose, lipids and amino acids. An IP injection of glucose 25% (1 g/kg) produced a peak level in the serum within 40 min. A 20% fat solution (1 g/kg) showed maximum serum levels of triglycerides and total lipid in 2.5 h, while a standard amino acid solution (1.5 g/kg) enriched with 25 14C-phenylalanine peaked serum levels in 16 min. The 4 rabbits survived for 28 days with IP glucose, amino acids and lipids as the only form of nutrition, apart from water. When sacrificed after 28 days histology of peritoneum, liver, spleen, gut and kidney showed no abnormality. We conclude that the basic nutritional components are adequately absorbed through the peritoneum, and that long-term nutritional support can be achieved uneventfully with IP administration of nutritional solutions.

Absorption↗
PubMed1988

Infected echinococcal cyst. A common cause of pyogenic hepatic abscess.

Twenty-one cases of hepatic abscesses treated during a period of four years (from 1981 to 1985) at the University of Patras, Greece, are presented. This material includes 10 cases with abscesses caused by suppurated echinococcal cysts, corresponding to 21% of the total number of 47 cases of echinococcal cysts of the liver treated at our department during the same period. A preoperative diagnosis of the suppurated echinococcal cysts by conventional laboratory methods was not reliable. Because of the high frequency of echinococcal disease in our region and the risk of contamination of the peritoneal cavity from echinococcal parasites if the cyst is punctured, the new therapeutic techniques of treating hepatic abscesses by percutaneous drainage have not been applied. The exclusive method of treatment used was surgical drainage which had a satisfactory outcome and a mortality rate as low as 9%.

Adult↗