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Biomedical subjects

K Athanassiadi

Publications and source records attributed to K Athanassiadi.

16 recordsLinked to original sources
PubMed2006

Surgical management of late postpneumonectomy bronchopleural fistula: the transsternal, transpericardial route.

BACKGROUND: Late postpneumonectomy bronchopleural fistula (LBPF) is a serious complication. Surgical repair of the bronchial stump through a lateral thoracotomy is a dangerous attempt due to mediastinal fibrothorax and the risk of pulmonary artery stump damage. OBJECTIVES: The goal of this study was to estimate the effectiveness of the transsternal, transpericardial approach for bronchial stump repair in case of LBPF. METHODS: From 1996 to 2002, 1,294 lung resections for non-small cell lung cancer were performed at our department. Out of 412 pneumonectomies, 16 patients (3.8%) presented with LBPF after right pneumonectomy for non-small cell lung cancer. Thirteen of these patients were subjected to transsternal, transpericardial bronchial stump repair. They were followed postoperatively, and morbidity and mortality rates were recorded. RESULTS: The interval between pneumonectomy and fistula diagnosis lasted from 12 to 85 months. The estimated sizes of the fistulae ranged from 5 to 21 mm, and the length of the bronchial stump was >1 cm only in 2 patients (15.3%).Due to persistent empyema, open-window thoracostomy was performed for definite treatment immediately after the operation for bronchial stump reamputation in 6 cases (46.1%). One patient (7.6%) died 3 months postoperatively due to bronchopleural fistula recurrence. This was also the only case of fistula recurrence. CONCLUSION: LBPF usually needs definite management to save the patient's life. The transsternal, transpericardial approach is a safe and effective method.

Aged↗
PubMed2005

Postresectional pulmonary oxidative stress in lung cancer patients. The role of one-lung ventilation.

OBJECTIVE: The authors conducted a prospective analysis in order to investigate through lipid peroxidation metabolites the generation of oxygen free radicals after one-lung ventilation (OLV). METHODS: From 2001 to 2003, 212 patients were prospectively studied for lung reexpansion/reperfusion injury. They were classified in six groups. Group A, non-OLV lobectomy group; B, OLV pneumonectomy group; C-E, OLV lobectomy of 60, 90, and 120 min duration, respectively; F, normal subjects as baseline group. Preoperative, intraoperative and postoperative strict blood sampling protocol was followed. Malondialdehyde (MDA) plasma levels were measured. The recorded values were analyzed and statistically compared between groups and within each one. RESULTS: Comparison of groups C-E (OLV) to all other documented significant (P<0.001) increase of MDA levels during lung reexpansion and for the following 12h. The magnitude of oxidative stress was related to OLV duration (group E>D>C, all P<0.001). The removal of cancer-associated parenchyma led to MDA level decrease postoperatively (P<0.001) especially after pneumonectomy (A vs. B, P<0.001). CONCLUSIONS: (1) Lung reexpansion provoked severe oxidative stress. (2) The degree of the amount of generated oxygen free radicals was associated to the duration of OLV. (3) Patients with lung cancer had a higher production of oxygen free radicals than normal population. (4)Tumor resection removes a large oxidative burden from the organism. (5) Mechanical ventilation and surgical trauma are weak free radical generators. (6) Manipulated lung tissue is also a source of oxygen free radicals, not only intraoperatively but also for several hours later.

Adult↗
PubMed2004

Skip metastases: analysis of their clinical significance and prognosis in the IIIA stage of non-small cell lung cancer.

OBJECTIVE: To determine the clinical significance of skip metastases (pN2/S) in patients with resected pIIIA/N2 NSCLC. The incidence of pN2/S after mediastinal lymph node dissection (MLD) and sampling (MLS) were compared. METHOD: From 1997 to 2000, 580 lung resections for NSCLC performed at our department. The 151 patients (26.5%) at stage IIIA/N2 (pN2+) were grouped according to their skip metastases status. Group A included the ordinary pN2 (pN2/O) cases (71%) and group B the pN2/S (29%). Age, gender, type of resection, right or left lesion, histology, tumor lobe predilection, MLD or MLS pathologic results, the level and the number of node stations involved and survival were analyzed. RESULTS: In 44 patients (29%) pN2/S disease was present. Statistical analysis revealed significant difference between pN2/O and pN2/S for the following: (1) pN2/S was more common for right-sided lesions (P=0.007); (2) Squamous carcinoma was the main type of pN2/S (P=0.007) and (3) pN2/S was more frequently detected after MLD than after MLS (P=0.001). Although pN2/S involved more often upper mediastinal lymph nodes (Nos. 2, 3) and one station level (pN2/S: 41 vs. pN2/O: 19.6%, P=0.228) was not found statistically significant. pN2/O was more common after right upper lobectomy and pN2/S after right lower lobectomy. The 3-year survival was more favorable for the pN2/S group (A: 24 vs. B: 36%, P=0.07). CONCLUSION: (1) MLD was found to be more reliable for pN2/S detection than MLS. (2) The presence of pN2/S proved to be a less aggressive form of lymphatic spread that should be taken into account in the future. (3) Strong correlation between right lower lobe tumors and pN2/S was demonstrated. (4) Different routes of cancer lymphatic spread between pN2/S and pN2/O are suggested.

Adult↗
PubMed2004

A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma.

OBJECTIVES: A prospective analysis was conducted to define the incidence of occult pneumothorax (OPX), delayed pneumothorax (DPX) and delayed hemothorax (DHX) and to propose an algorithm for surveillance. METHODS: During the last 2 years 709 consecutive patients who did not fulfill the indications for intrahospital management were examined at our emergency department for blunt thoracic injury. All patients were subjected to expiration posteroanterior chest radiograph (eCXR) and were scheduled for reevaluation after 24, 48 h and at 7, 14 and 21 days. RESULTS: OPX was present in 28 patients (4%) detected only with eCXR on admission, 14 patients developed DPX (2%) at 24-48 h later, and 52 patients presented up to 14 days later with DHX (7.4%). Of all DHX 42 (80.7%) required chest tube drainage, eight thoracentesis (16%) and only two (4%) were subjected after 1 month to decortication. No related morbidity was recorded. All the patients with the DHX had at least one rib fractured. Only one death among the DHX patients was documented. CONCLUSIONS: A safe algorithm is recommended: eCXR for every patient who suffered blunt thoracic injury with at least one rib fracture detected and is treated as an outpatient or in case his/her compliance with the reevaluation schedule will be suboptimal. Close follow-up is also suggested since these entities do exist, cannot be ignored and their treatment is early evacuation of the pleura cavity.

Adult↗
PubMed2004

Late postpneumonectomy bronchopleural fistula.

OBJECTIVE: The incidence of late postpneumonectomy bronchopleural fistula (PBPF) is very small after the 3rd postoperative week due to the existence of fibrothorax providing an effective natural protection against fistula formation. However, the development of late PBPF is a serious complication characterized by high morbidity and mortality. We present our modest experience in treating 11 patients with late PBPF using the transsternal transpericardial approach. MATERIAL: Between 1996 and 1999, 11 male patients with a mean age of 61 years were treated in our department for late PBPF (diameter > 5 mm). The interval between pneumonectomy and fistula creation ranged from 1 to 10 years. The initial operation was right pneumonectomy in all cases due to lung cancer. pTNM stage was either II or IIIA. Bronchoscopically no recurrence was observed and empyema was present in all cases. RESULTS: The initial treatment consisted of tube thoracostomy. We proceeded to direct bronchial stump repair transpericardially with omental flap coverage and finally open window thoracostomy. Neither deaths nor major complications occurred perioperatively. The ICU and hospital stay ranged from 5 to 10 and 30 to 45 days, respectively. During a follow-up of 10 to 28 months no recurrence was observed. CONCLUSIONS: 1. The management of late large PBPF can be only surgical. 2. Fibrothorax and empyema makes the approach through thoracotomy impossible and dangerous for dissection and repair. 3. Bronchial stump repair through the transpericardial approach by median sternotomy is very effective in late PBPF cases where the patient's general condition is good, allowing a major intervention.

Bronchial Fistula↗
PubMed2003

Treatment of post-pneumonic empyema thoracis.

OBJECTIVE: The present study evaluates the management of 65 consecutive patients with post-pneumonic empyema thoracis (PET) treated in our department during the last ten years. MATERIALS: There were 51 male (78.5 %) and 14 female (21.5 %) aged 23 - 82 years. The initial cause of PET was pneumonia (postoperative and posttraumatic empyemas were excluded). In 2 cases, a bronchopleural fistula coexisted. Diagnosis was based on clinical, radiological and pleural fluid culture findings. Pneumonococci and staphylococci were the predominant bacterial isolates in our series. RESULTS: Tube thoracostomy drainage (TS) was performed in all our patients. Forty-nine patients (75.4 %) were successfully treated with TS alone. The other 16 patients were submitted to thoracotomy: lung decortication (n = 14) along with segmentectomy in two cases and the Eloesser procedure, also in two cases. The mortality rate reached 9.2 % (n = 6). Septic shock, multiple organ failure, cardiac insufficiency, and end-stage renal failure were the causes. CONCLUSIONS: 1. Complete drainage and full lung expansion by tube thoracostomy with suction are essential in the management of post-pneumonic empyema thoracis. Surgery should only be carried out right away if these conditions are not achieved. 2. Despite clinical experience and the major strategies and procedures available, the mortality remains high.

Adult↗
PubMed2001

Treatment of thoracic outlet syndrome: long-term results.

Thoracic outlet syndrome (TOS) refers to a complex of symptoms in the upper extremity caused by compression of the neural and vascular structures at some point between the interscalene triangle and the inferior border of the axilla. A review of our experience in treating this controversial syndrome is presented. Between 1989 and 1997 a series of 23 patients (5 men, 18 women) were operated on for TOS. The average age of the patients was 26.4 years (range 17-60 years). All patients complained of pain typically in the shoulder and proximal upper extremity with radiation to the neck, and most had paresthesias and numbness in the forearm and hand. Their symptoms had been present for 8 months to 9 years (mean 2.6 years). All were evaluated by history, physical examination, radiographs of the chest and cervical spine, electromyography, and nerve conduction studies; computed tomography, magnetic resonance imaging, angiography, and myelography were conducted selectively. When TOS was suspected, a cooperative concept was utilized employing the aid of the neurologist, orthopedist, and occasionally a cardiologist. The initial treatment was physical therapy for a minimum of 6 weeks. If no relief occurred they underwent surgery. In all patients in the present series the first rib was removed through a transaxillary approach. A cervical rib was also removed in four cases. Postoperatively, they were evaluated by questionnaire and reexamination. Nineteen (82.6%) had complete relief, and four had partial relief of symptoms. Complications included pneumothorax and temporary brachial paralysis in one case each. We concluded that careful selection of patients for surgery can yield satisfactory results, and a coordinated team of thoracic surgeons, neurologists, and physical therapists is important for management of these patients.

Adolescent↗
PubMed2001

Primary chest wall tumors: early and long-term results of surgical treatment.

OBJECTIVES: A retrospective study of primary chest wall tumors (PCWTs/CWTs) was conducted to review their clinical, radiological and pathological features, as well as the early and long-term results of surgical management. MATERIALS AND METHODS: From 1986 through 1996, 41 patients (18/44% male, 23/56% female, aged 15-78 years) with PCWTs were treated in our department. RESULTS: Twenty-three patients (nine male, 14 female, mean age 36 years) had a benign CWT: enchondroma, five patients; fibrous dysplasia, four patients; neurilemmoma, three patients; osteochondroma, two patients; granular cell tumor, two patients; fibroma, two patients; lipoma, two patients; fibrolipoma, one patient; eosinophilic granuloma, one patient; aneurysmal bone cyst, one patient. Eighteen patients (nine male, nine female, mean age 59 years) had a malignant CWT: plasmacytoma, five patients; chondrosarcoma, two patients; osteosarcoma, two patients; fibrosarcoma, two patients; desmoid tumor, two patients; leiomyosarcoma, one patient; malignant fibrous histiocytoma, one patient; tendon sheath sarcoma, one patient; hemangiosarcoma, one patient; neurinosarcoma, one patient. The ribs were involved in 21 patients, the sternum in five patients, and the soft tissue in 17 patients. Distinction between benign and malignant CWT was not possible using radiographic criteria alone, and diagnosis was always confirmed histologically. Surgical treatment consisted of wide resection in 29 patients (15 benign/14 malignant CWTs), with the use of synthetic mesh in five cases, and excisional or incisional biopsy in 12 patients. There was no perioperative mortality. Two patients with a benign CWT (fibroma, one patient; neurilemmoma, one patient) had a local recurrence at 13 and 26 months after resection, respectively, and underwent wide resection (recurrence rate 8.7%). Follow-up at 3-13 years revealed one non-tumor-related death in patients with benign CWT (overall mortality rate 4.3%) and no other local recurrence. The overall 5- and 10-year survival in patients with malignant CWT was 33.3%. CONCLUSIONS: We believe that all CWTs should be considered malignant until proven otherwise. Wide resection with tumor-free margins is required in order to provide the best chance for cure in both benign and malignant lesions.

Adolescent↗
PubMed2000

Management of foreign bodies in the tracheobronchial tree in adults: a 10-year experience.

OBJECTIVE: To report our experience of foreign bodies in the tracheobronchial tree in adults. DESIGN: Retrospective study. SETTING: Teaching hospital, Athens. SUBJECTS: 25 patients referred to the department of thoracic surgery for treatment. INTERVENTIONS: Bronchoscopic extraction in 16, thoracotomy with bronchotomy in 5, and resection in 4. RESULTS: No major complications and no deaths. CONCLUSION: Bronchoscopic extraction is usually possible, but thoracotomy and bronchotomy or resection may be necessary.

Adult↗
PubMed1999

Surgical repair of postinfarction ventricular septal defect: 10-year experience.

Postinfarction ventricular septal defect (PIVSD) remains a surgical challenge resulting in devastating mortality rates. We present our 10-year experience in surgical management of this catastrophic complication of acute myocardial infarction. During a decade (1987-1996) 14 patients with PIVSD were treated surgically in our department. There were 10 men and 4 women, ranging in age from 51 to 78 years. The rupture occurred within the first 4 days after the infarction in most cases (n = 10). Eight patients were supported perioperatively by intraaortic balloon counterpulsation (IABP). In all cases the surgical technique included infarctectomy and ventricular septum reconstruction with synthetic patches. Coronary artery bypass grafting was synchronously performed in four patients. Seven patients died perioperatively (mortality rate 50%) due to heart failure and to multiple organ failure. The most frequent complications were low cardiac output syndrome, hemorrhage, and respiratory and renal insufficiency. The PIVSD needs urgent surgical intervention with the patient hemodynamically stable after cardiac catheterization. Long-term results are favorable for survivors.

Aged↗
PubMed1999

Blunt diaphragmatic rupture.

OBJECTIVE: To identify (1) predictors of outcome in blunt diaphragmatic rupture (BDR), and (2) factors contributing to diagnostic delay. METHODS: We reviewed the charts and radiographs of 41 patients with BDR treated in our Hospital from 1988 to 1997. There were 35 male (85%) and six female, aged 17-71 (mean: 41) years. BDR was left-sided in 24 cases (58%), right-sided in 15 (36%) and bilateral in two (5%). RESULTS: Two groups of patients can be identified: group A (n = 36, 88%) with acute BDR, and group B (n = 5, 12%) with post-traumatic diaphragmatic hernia (TDH). In group A, immediate diagnosis was made in 35 cases (97%), but only in 26 (72%) preoperatively. In one case, a right BDR was missed on initial evaluation but became apparent 2 weeks later. Associated injuries were present in 34 patients (94%) involving: spleen (n = 18), rib fractures (n = 17), liver (n = 14), lung (n = 11), bowel (n = 7), kidney (n = 5) and other fractures (n = 21). Injury Severity Score (ISS) ranged from 9 to 66 (mean: 31). BDR repair was accomplished through a laparotomy in 22 cases, thoracotomy in 10 and laparo-thoracotomy in four. The overall mortality rate was 16.6% (6/36). Both patients with bilateral BDR died. The patients who died were older than the survivors (mean age: 54 vs. 39 years, P<0.05), were more severely injured (mean ISS: 46 vs. 28, P<0.05) and were in shock (100 vs. 23%, P<0.05). In group B with TDH, diagnosis was delayed for 7-16 months after injury. Four patients had non-specific clinical signs and one strangulation of hollow viscera. One patient had undergone surgery during acute injury but BDR was overlooked. Location of TDH was on the left in three cases and on the right in two. Delay in BDR diagnosis was 12.5% (3/24) in patients with left-sided and 20% (3/15) in patients with right-sided lesions (P>0.1). Repair of TDH was achieved through thoracotomy in all cases. No mortality or major morbidity were encountered. CONCLUSIONS: (1) Predictors of BDR mortality are: age, ISS and hemodynamic status of the patient. (2) Delay in diagnosis does not influence the outcome and is not influenced by the side of BDR location. (3) BDR can easily be missed in the absence of other indications for prompt surgery, where a thorough examination of both hemidiaphragms is mandatory. A high index of suspicion combined with repeated and selective radiologic evaluation is necessary for early diagnosis.

Adolescent↗
PubMed1999

Bronchopleural fistula after pneumonectomy: a major challenge.

OBJECTIVE: Bronchopleural fistula (BPF) is a life-threatening complication of pneumonectomy. Its treatment still challenges the thoracic surgeon. We present our 10-year experience in the management of this entity. MATERIAL: From 1986 to 1997, 8 patients with BPF, representing 2.5% of the 315 pneumonectomies performed in the same period, were treated in our Department. All were male, aged 52-74 (mean: 62.5) years. Pneumonectomy (right: 5, left: 3) was undertaken due to lung cancer. BPF occurred within one month postoperatively. RESULTS: No difference in BPF incidence was observed comparing hand suturing and stapling of the bronchial stump. BPF was associated with empyema thoracis (ET) in 5 patients. Methods of management included prolonged chest tube drainage (n = 5), open thoracostomy (n = 3), bronchoscopical injection of fibrin sealant (n = 2), BPF closure through the previous thoracotomy with autologous tissue buttress (n = 2), transternal transpericardial closure of the BPF (n = 1). Two patients died (mortality 25%): one patient treated with chest tube drainage due to myocardial infarction, and the other undergone transternal BPF closure due to sepsis. In the rest 6 patients closure of the BPF was achieved. CONCLUSION: BPF after pneumonectomy continues to be a problem without definite solution at present. Prevention has not been achieved with the use of staples for bronchial stump closure. Small leaks may be scaled endoscopically with fibrin glue. Otherwise, early surgical closure is mandatory, especially when empyema thoracis coexists.

Aged↗
PubMed1998

Surgical treatment of spontaneous pneumothorax: ten-year experience.

Spontaneous pneumothorax (SP) is commonly observed in young, tall, thin subjects without apparent underlying lung disease and in the elderly with chronic emphysematous lung disease. We present our experience in treating SP during the last decade. From December 1986 to November 1996 a total of 417 consecutive patients with SP were admitted to our department. There were 349 males (83.7%) and 68 females, ranging in age from 14 to 93 years. A right-side SP was detected in 234 cases (56.1%), a left-side SP in 175 (42.0%), and a bilateral SP IN 8 (1.9%). Treatment included observation/aspiration (n = 16, 3.8%), tube thoracostomy (n = 372, 89.2%), multiple tubes (n = 29, 7.0%) blood pleurodesis (n = 13, 3.1%), midsternotomy (n = 3, 0.7%), and minithoracotomy (n = 92, 22.1%). Primary indications for operation were recurrent SP (n = 49) and persistent air leak (n = 46). Blebs or bullae were found in all patients and were ablated by stapling. Pleural abrasion was also performed. All showed good lung expansion postoperatively. Perioperative mortality was zero. The mean hospital stay was 6.5 days. Follow-up of 89 patients who had undergone surgical treatment (93.75) at 1 to 100 months revealed only one recurrence. Tube thoracostomy is still in cases of recurrent SP or persistent air leak. Minithoracotomy is a safe surgical approach with satisfactory cosmetic results.

Adolescent↗
PubMed1998

Surgical treatment of echinococcosis by a transthoracic approach: a review of 85 cases.

OBJECTIVE: Human echinococcosis remains a serious health problem for the Mediterranean countries, among them Greece. As there is no effective medical therapy, surgery is still the treatment of choice. MATERIAL AND METHODS: We present our experience in the surgical management of hydatidosis by a transthoracic approach, based on 85 patients (49 male, 36 female, aged 4-86 years) treated during 1986-1996. RESULTS: Twenty-one patients (26.3%) appeared with complications as: hydatidemesis (n = 5), hydropneumothorax (n = 3), cyst infection (n = 3), empyema thoracis (n = 8), cholebronchial (n = 3) and cholebronchopleural fistula (n = 1). The location of the cysts was: 61 in the lungs (right, 29; left, 24; bilateral, eight), 31 on the liver dome, six in the pleural cavity, two in the mediastinum, and one in each of pericardium, chest wall, and right pararenal space. Surgical approach involved a thoracotomy or median sternotomy in all cases. Pulmonary endocystectomy and capitonnage was the procedure of choice in the surgical management. Hepatic cysts were approached through a right thoracophrenotomy and were managed with evacuation of the main and daughter cysts, suture of the diaphragm to the margins of the cyst, and drainage of the cystic and pleural cavities. There was no in-hospital mortality. Major postoperative complications were: empyema thoracis (n = 3), biliary fistula (n = 2), and bronchopleural fistula (n = 1). Five patients presented later with seven recurrences of the disease. CONCLUSION: Transthoracic approach is a good and safe choice in surgical treatment of both the intrathoracic and the (concomitant or not) hydatid cysts on the upper surface of the liver.

Adult↗