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Kalliopi Athanassiadi

Publications and source records attributed to Kalliopi Athanassiadi.

14 recordsLinked to original sources
PubMed2006

Percutaneous radiofrequency thermal ablation of primary and metastatic lung tumors.

OBJECTIVE: Primary lung cancer is the leading cause of death from cancer. For patients with inoperable lung cancer, percutaneous radiofrequency thermal ablation (RFA) under CT-guidance represents a minimally invasive treatment. It can also be applied in combination with radiation therapy and chemotherapy. MATERIALS AND METHODS: In a period of 18 months, RFA under CT-guidance 27 ablations were applied on 22 patients, 14 patients with primary lung cancer and 8 patients with metastatic lung tumor. There were 15 men and 7 women ranging in age between 48 and 79 years. All patients were not surgical candidates either due to the advanced stage or due to comorbid diseases, while five denied surgery. The lesions' size was no bigger than 6 cm (range 1-6 cm) with an average of 3.8 cm. The diagnosis of all treated lesions was obtained with percutaneous biopsy under CT guidance. The procedure was performed under local anesthesia. RESULTS: There were no major complications observed, but a small pneumothorax and a minor hemoptysis in four cases, all conservatively treated. All patients were hospitalized for 24h. Follow-up was initially done in 1, 3, 6 and 12 months after RFA and it was accomplished by personal interview or by telephone call up to December 2005. Median progression free intervals were 26.4 months for primary lung cancer and 29.2 months for metastatic tumor. CONCLUSION: RFA is a minimally invasive technique that can be used as a palliative treatment in nonsurgical candidates with primary or metastatic lung tumor with a low morbidity and mortality.

Aged↗
PubMed2006

Massive hemorrhage caused by major pulmonary vessel-cutaneous fistula in the late postoperative period: report of two cases.

Sudden life-threatening hemorrhage caused by erosion of the wall of a thoracic blood vessel such as the aorta, pulmonary artery, or pulmonary vein, in the late postoperative period is extremely rare and presents a challenging emergency. We report the cases of two patients whose only clinical manifestation was a hemorrhagic cutaneous chest wall fistula. Both patients were treated by emergency surgery. The diagnosis and management of this clinical entity requires a high index of suspicion and innovative therapeutic solutions.

Arteriovenous Fistula↗
PubMed2005

Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study.

OBJECTIVE: A prospective randomized study was conducted in order to analyze the role of fibrinolytics in the treatment of complicated parapneumonic effusion. METHODS: From 2001 to 2004, 127 consecutive patients were managed for thoracic empyema. In all cases the cause was bacterial pneumonia. Seventy patients were managed with sole tube thoracostomy (group A) and 57 with combination of tube thoracostomy and streptokinase instillation (group B). Groups were statistically compared for the age, gender, duration of symptoms, quality of pleural fluid, chest imaging, complete drainage, length of hospital stay and mortality. Multivariate analysis was used in order to define the factors that affect outcome. RESULTS: Tube thoracostomy was successful in 47 (67.1%) cases (group A), while fibrinolysis led to a favorable outcome in 50 cases (87.7%) (P<0.05). The length of stay in thoracic surgical department was significantly longer for group A (P<0.001). Mortality rate in group A was significantly higher (P<0.001). Multiple regression analysis disclosed as sole independent favorable factor for pleural drainage, the use of fibrinolysis during the course of chest tube drainage (P=0.006, odds ratio 4.29, 95% CI 1.51-12.14). CONCLUSIONS: Fibrinolytic agents are a useful adjunct in the management of complicated parapneumonic effusions. Intrapleural fibrinolytics, if used early in the fibrinopurulent stage of a parapneumonic effusion, decrease the rate of surgical interventions (VATS or open decortcation) and the length of hospital stay with minor associated morbidity.

Adult↗
PubMed2005

Repair of postintubation tracheoesophageal fistula in polytrauma patients.

OBJECTIVE: We present our modest experience in treating tracheoesophageal fistula (TEF) in polytrauma patients where tracheal resection turns to be risky due to the size of the fistula and to the general condition of the patient. MATERIALS AND METHODS: Four polytrauma patients, three male and one female were treated at our department due to postintubation TEF. Confirmation was obtained endoscopically and radiologically. Surgical treatment consisted of identification and dissection of the fistulous tract and closure of the tracheal defect by transposing strap muscles and suturing them to the defect. Finally, the oesophageal defect was closed and a flap of sternocleidomastoid muscle was interposed between oesophagus and trachea. RESULTS: There was no intraoperative mortality. Three of our patients had an excellent result. The one who unfortunately returned to mechanical ventilation due to respiratory insufficiency developed a recurrent fistula. CONCLUSIONS: (1) Repair of postintubation TEF should be delayed until the patient is fully stabilised and weaned from ventilation. (2) Indirect closure of the tracheal defect with strap muscle transposition and sternocleidomastoid muscle interposition between oesophagus and trachea can be lifesaving.

Adolescent↗
PubMed2004

Spontaneous hemopneumothorax: a rare but life-threatening entity.

OBJECTIVES: Spontaneous hemopneumothorax (SHP) is a rare disorder, complicating 1-12% of patients with spontaneous pneumothorax. We conducted a retrospective review in order to study this potentially life-threatening condition and compared our experience with reports in the international literature. METHODS: Between 1970 and 2000, 3489 patients were treated in our department with spontaneous pneumothorax. Seventy-one of them (2%), 63 men and 8 women, aged between 13 and 80 years, presented SHP. Patients presented dyspnea and chest pain. In the majority, chest X-ray confirmed the diagnosis of hydropneumothorax. RESULTS: All our patients were initially treated with tube thoracostomy or thoracocentesis. Conservative treatment alone was effective in 16 cases (22.5%). Among the other 55 patients (77.5%), 28 (39.4%) were operated on an emergency basis since they were in shock, while 27 (38%) were electively led to surgery for clot evacuation, resection of the bulla, ligation of the adhesion between the parietal and visceral pleura and irrigation of the pleural cavity through thoracotomy. Postoperative course was uneventful and the patients were discharged from the hospital within 7-12 days. CONCLUSIONS: (1) SHP is a rare clinical entity that can lead to potentially life-threatening complications. (2) Early thoracotomy should be considered once the diagnosis of SHP is confirmed.

Adolescent↗
PubMed2004

Management of 150 flail chest injuries: analysis of risk factors affecting outcome.

OBJECTIVE: Flail chest continues to be an important injury with significant complications. The records of 150 patients presenting with flail chest injury were reviewed to determine risk factors affecting morbidity and mortality. MATERIAL AND METHOD: During a 7-year period 150 patients with a flail chest injury were admitted to our trauma center. There were 111 men (74%) and 39 women (26%) ranging in age from 18 to 88 years with a mean age of 56.9. Only 66 (44%) had an isolated flail chest injury on admission. The majority of patients were older than 55 years (n = 89, 59.3%), 80 (53.3%) presented with an hemo-, or/and pneumothorax, 36 (24%) sustained a head injury and 25 (16.7%) needed ICU monitoring. The mean ISS score was 38. Age, concomitant diseases, presence of pneumothorax and/or hemothorax, Severity Score (ISS), the need for mechanical support, length of stay and deaths were evaluated by using the t-test and chi2 test where appropriate. RESULTS: Sixty-seven patients (44.6%) were conservatively treated, while 80 (53.3%) needed thoracic drainage. Only in 6 cases (4%) thoracotomy was required, while in 9 (6%) laparotomy was performed. Mortality rate reached 5.3%. The main factors correlated with an adverse outcome were: ISS and the presence of associated injuries, while age, hemopneumothorax and mechanical support affected the length of hospitalization but not the mortality. CONCLUSIONS: (1) Age and hemopneumothorax did not affect mortality. (2) ISS was found to a strong predictor on outcome concerning morbidity and prolonged hospitalization but did not influence mortality rate. (3) Mechanical support was not considered a necessity for the treatment of flail chest.

Adolescent↗
PubMed2003

Spontaneous pneumomediastinum: a rare benign entity.

OBJECTIVE: Spontaneous pneumomediastinum usually occurs in young people without an apparent precipitating factor or disease. Thoracic surgeons are involved in the diagnosis and management of this entity because of the potentially life-threatening conditions that either must be treated as an emergency or excluded, such as esophageal perforation or necrotizing mediastinitis. We present our modest experience in treating spontaneous pneumomediastinum. MATERIALS: Between 1988 and 1998 we treated 22 cases of spontaneous pneumomediastinum in 18 male patients and 4 female patients, ranging in age between 12 and 32 years. All traumatic cases were excluded. Retrosternal chest pain was the main symptom the patients presented. In only 11 cases was subcutaneous emphysema present. Chest radiography was diagnostic in all our cases. Computed tomographic scan, when performed, confirmed the diagnosis. An esophagogram was essential to exclude an esophageal rupture. Last, a cardiologic examination especially focusing on pericarditis excluded cardiac disease. RESULTS: Conservative treatment consisted of bed rest, oxygen therapy, and analgesics, which led to rapid resolution of the spontaneous pneumomediastinum. The mean hospital stay ranged between 3 and 10 days. In a follow-up of 3 to 12 years only 1 recurrence was observed. CONCLUSION: Spontaneous pneumomediastinum is usually an undiagnosed benign entity that responds very well to conservative treatment. It should be considered in the differential diagnosis of chest pain, especially in healthy adolescents and young adults.

Adolescent↗
PubMed2003

Primary traumatic pulmonary pseudocysts: a rare entity.

OBJECTIVE: Pulmonary contusion is the usual manifestation of lung parenchymal injury after blunt chest trauma. With deceleration these parenchymal lacerations can result in cavities known as primary traumatic pulmonary pseudocysts (TPPC). We present our experience in treating this rare entity. MATERIAL: From 1989 trough 1999, 14 young patients, 11 male and three female ranging in age between 13 and 24 years were treated for primary TPPC in our department. Blunt chest injuries resulting from traffic accidents were the causes in all our cases. The main symptoms were pain, hemoptysis and dyspnea not associated with severe hypoxemia. The cavitary lesion was apparent in chest radiographs, but the imaging modality of choice was the computed tomography. RESULTS: Multisystem injury was present in 7 of them. Two of our patients required ICU facilities but none needed mechanical ventilation. Hemopneumothorax was present in two cases, whereas pneumothorax in four drained by tube thoracostomy. The hospital stay ranged between 9 and 23 days. Contraction and complete radiological resolution of the PPC needed a follow up of 6-11 weeks. CONCLUSIONS: (1) Primary traumatic pulmonary pseudocysts are benign lesions secondary to blunt chest trauma needing only conservative treatment unless complications arise, such as hemo- or pneumothorax or infection of the cavitary lesion. (2) Computed tomography is a really sensitive method for early detection of the lesion while plain roentgenograms are sufficient for the follow up.

Adolescent↗
PubMed2002

Modified technique of percutaneous dilational tracheostomy in 600 cases.

Tracheostomy is frequently required for the treatment of critically ill patients to prevent the complications with prolonged translaryngeal intubation. It may facilitate airway suctioning and improve patient comfort during the process of weaning. The purpose of the study was to introduce a new modified technique for percutaneous dilational tracheostomy (MPDT) and assess its advantages. From November 1997 through December 2000, a series of 600 patients (350 men, 250 women; mean age 44.5 years) underwent MPDT in our department. The technique we used is a combination of the Seldinger and Schachner techniques with an incision of 2 to 3 cm between the cricoid cartilage and the notch. Using a small automatic retractor, the thyroid muscles were dissected with the help of a curved mosquito clamp. This gave us the opportunity to control the isthmus and offered the possibility of ligation when the thyroid was large, providing a good operative field directly on the trachea. Hence we avoided traumatizing the isthmus, which is the main source of hemorrhage during this procedure. The mean operating time was 4.5 minutes. The morbidity rate was 0.04%. One patient developed a subcutaneous emphysema and in three cases we had to ligate the external jugular vein. The surgical incision was completely healed within 3 to 4 days after removing the tracheostoma. No tracheal stenoses were observed during the follow-up. MPDT is a safe, applicable technique that can be performed quickly even by a nonsurgeon in the intensive care unit and emergency department, with a low risk of complications because there is a direct view of the trachea and minimal trauma.

Adult↗
PubMed2002

Sternal fractures: retrospective analysis of 100 cases.

Isolated sternal fractures are seen with increasing frequency in road accidents, especially since the introduction of seatbelt legislation. The medical records of all our patients who were treated with a diagnosis of sternal fracture (SF) over the past two decades were retrospectively reviewed to determine the incidence, morbidity, and mortality of this entity. Between 1984 and 1998, 100 consecutive patients were admitted to the Department of Surge Surgery, General Hospital of Nikea-Piraeus, Greece, for SF. There were 72 men and 28 women ranging in age between 17 and 84 years. Sixty-seven patients sustained an isolated SF and the remaining 33 had a SF in combination with multiple injuries such as flail chest (n = 19), head injury (n = 18), limb fractures (n = 10), spinal fractures (n = 4), hear contusion (n = 1), hemo-pneumothorax (n = 9), pneumothorax (n = 6), hemomediastinum (n = 5), and pericarditis (n = 2), among others. All patients with a radiological diagnosis were admitted for cardiac monitoring for at least 24 hours. Electrocardiogram (ECG), determinations of cardiac enzyme levels such as lactic dehydrogenase, creatine kinase, and creatine kinase-MB, and evaluation by a cardiologist were routinely performed. An echocardiogram was performed as indicated by the cardiologist. Seven patients underwent operation, two for abdominal bleeding, two for chest wall and sternal stabilization, two for open pneumothorax, and one for massive hemothorax. Eight of our patients needed ventilatory support. Four of them died from respiratory insufficiency, myocardial infarction, and heart and lung contusion. Although an isolated SF carries a good prognosis, careful evaluation and clinical observation are essential.

Accidental Falls↗
PubMed2002

Management of esophageal foreign bodies: a retrospective review of 400 cases.

OBJECTIVE: A retrospective study was conducted in 400 patients with esophageal foreign bodies (EFB) to assess characteristics of EFB and methods of treatment. METHODS: From 1962 through 1998, 400 patients with EFB were treated in our department on an emergency basis. There were 202 men (50%) and 198 women (49.6%) ranging in age from 1.5 to 95 years. The main symptoms patients complained of were difficulty in swallowing and pain. Detailed anamnesis, oropharynx and hypopharynx examination and finally radiological examination were the diagnostic tools. The location of the FB was in the cervical esophagus in 57% of cases, in the thoracic one in 26% and at the cardioesophageal junction in 17%. The most common objects found were bones, morsels, coins and needles. RESULTS: The treatment consisted of rigid esophagoscopy under general anesthesia in 343 (85.7%) of our cases. In 57 cases (14.3%) other means such as flexible esophagoscopy, Fogarty or Foley catheters and bougienage turned to be very useful. Only 12 patients (3%) were led to surgery because either extraction was impossible or perforation was present. No major complications occurred in the surgical group, whereas in the group of rigid esophagoscopy, there was one iatrogenous esophageal perforation that presented with empyema thoracis successfully treated. Finally, there was a case of an aortoesophageal fistula with mortal outcome perioperatively. CONCLUSIONS: (1) Esophagoscopy is a reliable method in the treatment of EFB impaction. (2) Alternative methods such as bougienage, etc., can be used only in selected cases with smooth foreign bodies. (3) Surgical treatment is unavoidable in cases of irretrievable EFB or esophageal perforation.

Adolescent↗
PubMed2002

Bronchobiliary fistulae due to echinococcosis.

OBJECTIVE: A bronchobiliary fistula (BBF) is a rare complication of echinococcosis due to rupture of hydatid cysts located at the upper surface of the liver to the bronchial tree. We present our experience in treating this uncommon and dangerous entity. MATERIAL: During the last 20 years, 21 patients, ten men and 11 women ranging in age from 26 to 83 years with a BBF were treated in our department. They presented dyspnea, biloptysis, cough or fever. Diagnostic imaging studies have been very helpful in identifying the communication and in delineating its location. The disease was limited to the liver in 11 cases, whereas in the rest ten cases, both liver and lung were involved. RESULTS: Right thoracotomy was the approach of choice. Our strategy consisted of adequate evacuation of the intrahepatic cysts, obliteration of the cyst space, freeing the adherent lung, dissection and closure of the BBF. Two deaths occurred due to anaphylactic shock and cardiac insufficiency. Follow up at 7-12 years did not reveal any recurrence. CONCLUSION: Although the incidence of echinococcosis has been decreased, the BBF still remains a serious complication with a high morbidity and mortality. Early diagnosis and management of septic associated complications are essential.

Adult↗