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Biomedical subjects

Kostas Papagiannopoulos

Publications and source records attributed to Kostas Papagiannopoulos.

9 recordsLinked to original sources

Combined severe pectus excavatum correction and aortic root replacement in Marfan's syndrome.

A 23-year-old man with Marfan's syndrome was admitted for repair of annulo-aortic ectasia and severe pectus excavatum. A submammary skin incision approach followed by bilateral subperichondrial resection of abnormal costal cartilages was performed. The left intercostal muscles and perichondrial sheaths were divided 2 inches lateral to the sternum in a parasternal fashion to place the retractor. The aortic root was replaced with a 23-mm St. Jude's composite graft (St. Jude Medical, Inc, St. Paul, MN). Chest wall reconstruction was completed with a high sternal osteotomy and support of the sternum was made with Gortex strips (W.L. Gore & Associates, Inc, Flagstaff, AZ). The patient made an uneventful recovery.

Adult↗

Successful treatment of a posttraumatic pulmonary artery pseudoaneurysm with coil embolization.

A 29-year-old man presented to the emergency department after having been stabbed in the posterior right hemithorax twice. He underwent thoracotomy for hemodynamic instability and continuous bleeding. His postoperative recovery was complicated by the incidental finding of a posttraumatic pseudoaneurysm of the pulmonary artery. We describe successful coil embolization of the aneurysmal sac avoiding any further surgical intervention.

Adult↗

Simultaneous double video mediastinoscopy and video mediastinotomy--a step forward.

Mediastinal lymph node biopsy plays a fundamental role in diagnosis, staging and management of lung cancer. We describe a novel method of using the video-mediastinoscope for concurrent cervical mediastinotomy and anterior mediastinoscopy. We have performed five concurrent procedures using this system in the last 14 months. In four cases, we assessed the aorto-pulmonary (A-P) window lymph nodes. In the fifth case, we performed a cervical mediastinoscopy for para-tracheal and sub-carinal lymphadenopathy followed by an anterior videomediastinotomy, video assisted intrapericardial assessment, direct tumour sampling and A-P window lymph nodal biopsies. Due to the excellent visualisation afforded by the Videomediastinoscope, we were able to avoid an open procedure in all cases. We believe that this represents a major benefit of the videomediastinoscope in select cases.

Aged↗

Staged pulmonary and hepatic metastasectomy in colorectal cancer--is it worth it?

OBJECTIVES: Resection of isolated pulmonary and hepatic metastases from colorectal cancer can offer potential cure. However, little data is available to determine the results of staged hepatic and pulmonary resections in the same patient. METHODS: We retrospectively reviewed all patients who underwent staged hepatic and pulmonary metastasectomy for colorectal cancer in our institute from September 1998 to May 2002. Probability of survival was estimated by the Kaplan-Meier method. RESULTS: Thirty-three metastasectomies (seven redo) were carried out in 26 patients. There were 19 male and 7 female patients with a mean age of 61 years (range 34-76 years). The mean disease-free interval for hepatic and pulmonary resection was 21.8 and 23.9 months, respectively. Sternotomy, thoracotomy and video assisted thoracoscopic approach were used in 3.03, 72.7 and 24.2% of patients, respectively. Wedge excision, lobectomy and pneumonectomy were carried out in 87.87, 9.09 and 3.03% of cases, respectively. There was one hospital death following acute respiratory failure after pneumonectomy. Mean follow-up was 23.3 months (range 2-71 months). The mean survival after last pulmonary resection was 34.7 months (SE 3.03 and 95% CI of 28.8-40.6). CONCLUSIONS: Our results support aggressive surgical management of pulmonary and hepatic metastases in colorectal cancer.

Adult↗

Empyema resulting from a true colopleural fistula complicating a perforated sigmoid diverticulum.

Empyemas developing after traumatic rupture of intraabdominal organs have been previously reported. We report a case of a true nontraumatic colopleural fistula following surgery for spontaneous rupture of a sigmoid diverticulum. The diagnosis was suspected by the presence of an air-containing tract seen in a computerized tomogram of chest and abdomen and was established with a contrast study. The empyema cavity was initially drained, followed by a laparotomy and fistulectomy with primary large bowel anastomosis and loop ileostomy. Although rare, colopleural fistulas present a diagnostic challenge and delayed management can lead to increased morbidity.

Colonic Diseases↗

Giant thymoma.

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Aged↗

An assessment of the expanded classification of congenital cystic adenomatoid malformations and their relationship to malignant transformation.

The purpose of this study was to review cases of congenital cystic adenomatoid malformations (CCAMs) arising in children and adults, in order to assess the recently expanded classification system for these lesions and their association with malignant transformation. Of 28 CCAMs, there were 16 type 1, 4 type 2, and 8 type 4 lesions, 12 of which presented in adults. Five of 16 type 1 CCAMs were accompanied by microscopic foci of bronchioloalveolar carcinoma; two others showed focal mucous cell hyperplasia. In two further cases, foci of nonmucinous atypical adenomatous hyperplasia were identified in the adjacent lung parenchyma. The bronchioloalveolar carcinomas showed less cytologic atypia, proliferative activity (Ki-67), and p53 expression than a comparative group of bronchioloalveolar carcinomas arising de novo, but this was not statistically significant (p = 0.15). Neither bronchioloalveolar carcinomas nor hyperplasia was identified in type 2 or type 4 CCAMs. Four of the eight type 4 CCAMs showed focal stromal hypercellularity, and one case subsequently developed a pleuropulmonary blastoma. We conclude that classification according to the current system is of clinical value. Bronchioloalveolar carcinomas arise in association with type 1 CCAMs, but recurrence following resection is exceptional. Type 4 CCAMs show histologic overlap with grade 1 pleuropulmonary blastomas, and distinction between these entities may not be possible on histology alone. However, stromal cellularity in a type 4 CCAM should raise the possibility of blastomatous transformation.

Adenocarcinoma, Bronchiolo-Alveolar↗