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Petros Perimenis

Publications and source records attributed to Petros Perimenis.

At least 19 recordsLinked to original sources
PubMed2006

The impact of long-term conventional treatment for overlap syndrome (obstructive sleep apnea and chronic obstructive pulmonary disease) on concurrent erectile dysfunction.

PURPOSE: To assess the improvement of concurrent erectile dysfunction (ED) in men with overlap syndrome (obstructive sleep apnea and chronic obstructive pulmonary disease), treated with continuous positive airway pressure (CPAP) and bronchodilators. MATERIAL AND METHODS: We evaluated 48 men of a mean age of 52.8+/-10 years suffering from both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), and concurrent ED. They were treated with conventional for pulmonary obstruction therapy (CPAP and bronchodilators) for 6 months and then their erectile function (EF) status was reassessed. ED was considered as improved, if ED intensity score increased for at least five points compared to that of baseline. The determinants for improvement of ED were also evaluated, as well as patient's personal degree of satisfaction with the treatment they received as far as the disorder was concerned. RESULTS: EF was improved in 12 patients (25%), but only two thirds of them were satisfied with the grade of improvement after treatment. ED improvement was related positively with age and apnea/hypopnea index and negatively with ED duration. ED intensity score, O(2) saturation at night and BMI were not significantly related to the outcome of EF improvement. CONCLUSIONS: Conventional treatment for OSA and COPD, has a positive effect on concurrent ED on the minority of patients. This effect is possibly due to the improvement of respiration during sleep with CPAP and of oxygenation with bronchodilators continuously. Of the improved men, one third was not satisfied with the impact of this treatment modality on their EF. It is likely that specific for ED treatment is needed in these individuals.

Age Factors↗
PubMed2006

Application of paclitaxel-eluting metal mesh stents within the pig ureter: an experimental study.

OBJECTIVE: The purpose of the present study is to compare the standard bare metal stents (BMS) with the Paclitaxel-Drug Eluting Stent (DES) in the ureter of a pig model. MATERIALS AND METHODS: We report on an experimental study with ten female pigs weighing between 25 and 30 kg. The stents were randomly placed in either the right or left ureter in each of 10 study animals, for a total of 20 stented ureters. Ten ureters were stented with an R-Stent (Orbus Medical Technologies, Hoevelaken Netherlands), and ten with a Paclitaxel-Eluting Coronary Stent (Boston Scientific, Natick, MA, USA). Patency was measured by radiograph of the nephrostomy tract, intravenous urography and virtual endoscopy at 24 hours and 21 days after the initial procedure, respectively. RESULTS: Free flow of urine through the stents into the bladder was documented in all stented ureters 24 hours after stent insertion by radiograph of the nephrostomy tract. At the 21 day follow-up examination, 5 R-Stents were found to be completely occluded and two partially stenosed, whereas no occluded stent was detected in the Paclitaxel-DES group. Pathology examination of the stents at 21 days follow-up showed that the obstructed R-Stents generated severe inflammation with metaplasia of the urothelium. The Paclitaxel-Eluting MS generated a mild inflammatory response within the ureteral lumen at the site of the stent, without hindering ureteral patency. R-stents proved to develop more hyperplasia compared to the Paclitaxel-Eluting MS. CONCLUSIONS: Paclitaxel-DES, when compared with the standard R- Stent BMS, generated less inflammation and/or hyperplasia of the surrounding tissues, thus maintaining ureteral patency. Long-term animal trials are required to further validate our results.

Animals↗
PubMed2006

Digital subtraction angiography and computer assisted image analysis for the evaluation of the antiangiogenetic effect of ionizing radiation on tumor angiogenesis.

PURPOSE: The aim of the present study was to evaluate and quantify the antiangiogenetic effect of ionizing radiation on tumor angiogenesis using digital subtraction angiography (DSA) in conjunction with computer assisted image analysis (CAIA). METHODS: Walker 256 carcinosarcoma was inoculated in both glutei of 12 Wistar rats. When the tumors reached a diameter of 1.5 cm, local irradiation of the right gluteus was performed. The left gluteus of each animal served as a control. After 24 hours of irradiation, angiography was performed, and images where digitized and subsequently processed. The effect of irradiation was observed both in big and small vessels (smaller or greater than 200 microm). RESULTS: Irradiated areas of both small and big vessels showed a statistically significant reduction in both total vessel area and length. Small vessels showed a greater trend toward suppression by irradiation (not statistically significant). CONCLUSION: Irradiation had a deleterious effect in both macro- and micro-blood supply of a tumor. The use of CAIA enhanced the efficacy of DSA and enabled the in vivo identification of the effect of irradiation on various caliber vessels as well as the ratios of total length and total area of small and big vessels.

Angiography, Digital Subtraction↗
PubMed2006

Case report: leiomyosarcoma of the renal pelvis.

We present a new case of leiomyosarcoma, a very rare clinical entity, arising from the renal pelvis. The primary diagnosis, based on asymptomatic gross hematuria and imaging findings, was tumor of the left kidney. After a left radical nephro-ureterectomy, histology confirmed a leiomyosarcoma of the renal pelvis. No adjuvant treatment was provided and the patient remains healthy 3 years after surgery.

Actins↗
PubMed2006

Case report: laparoscopic adrenalectomy in a patient with primary adrenal malignant melanoma.

We report a case of laparoscopic management of a primary malignant melanoma of the left adrenal gland. A 42-year-old male presented a 55 x 60-mm round, inhomogeneous, noninvasive mass of the left adrenal gland. Hormone-activity values were within normal range. The mass was removed laparoscopically en bloc along with the left adrenal gland, and its histopathologic evaluation was consistent with the features of a malignant melanocytic tumor. Postoperatively, the patient presented no signs of fever or remarkable blood loss and was discharged on the third day in good clinical condition. He is free of disease 1 year later.

Adrenal Gland Neoplasms↗
PubMed2006

Injectables for the treatment of stress urinary incontinence: current use and future perspectives.

Stress urinary incontinence is a prevalent symptom among women. It also affects men, primarily those operated on for prostate disease. Even though it is not life threatening, it seriously impacts quality of life. Bulking agents have been used in the treatment of incontinence for many decades, offering a treatment option for both women and men. Their short-term efficacy is satisfactory, but there is concern regarding durability of effect. Despite concerns regarding efficacy, the minimally invasive nature of the technique, with uncommon and self-limited complications, has made injectables quite popular among both physicians and patients. In light of recent developments in the surgical treatment of incontinence, resulting in highly efficacious, but also easy and safe-to-perform, procedures, the role of injectables must be re-evaluated. In these cost-conscious times, health economics is also an important issue, and comparative cost-effectiveness assessment of available treatment options is becoming imperative.

Animals↗
PubMed2006

Cost implications of antimuscarinic drugs in the treatment of overactive bladder syndrome.

Overactive bladder syndrome is highly prevalent, particularly among the elderly. As well as the consequent morbidity, such as urinary infections, skin irritation and bone fractures, almost all aspects of quality of life, personal and social, are influenced. Therefore, the associated cost is substantial. Pharmacotherapy with antimuscarinics is the mainstay of treatment. Because of the good balance between efficacy, safety and tolerability, these drugs seem to be cost-effective therapeutic modalities for overactive bladder. In the milieu of a constantly ageing population, rising demand for the treatment of health conditions and the need for rational use of healthcare resources, further studies with long-term antimuscarinic drug treatment and follow-up are needed to redefine their therapeutic value.

Cost-Benefit Analysis↗
PubMed2005

Retroperitoneal seminoma with 'burned out' phenomenon in the testis.

The rare 'burned out' phenomenon in germ cell tumors is known as the presence of an extragonadal germ cell tumor without traces of neoplasm in the testis. This condition is different and less common from the primary extragonadal germ cell malignancies. These malignancies are treated surgically with or without adjuvant chemotherapy or radiotherapy and their prognosis is better than that of other types of primary extragonadal tumors.

Adult↗
PubMed2005

Efficacy of the combination of an alpha1-blocker with an anticholinergic agent in the treatment of lower urinary tract symptoms associated with bladder outlet obstruction.

The combination of an alpha1-blocker with an anticholinergic is a new and promising therapeutic approach for bladder outlet obstruction and detrusor overactivity. Both placebo-controlled and comparative studies have demonstrated that the addition of an anticholinergic in the conventional treatment of patients with bladder outlet obstruction is safe, as the likelihood of acute urinary retention is low. Although the pathophysiology of detrusor overactivity is unknown and most probably multifactorial, it is not expected that the voiding phase is influenced by regular doses of anticholinergics, although high doses may affect detrusor contraction. However, safety issues must be studied further. The combination of tamsulosin with propiverine or tolterodine, and of doxasosin with tolterodine has been shown to cause a significant improvement of lower urinary tract symptoms when compared with alpha1-blocker monotherapy. Indisputably, the existing literature provides clear evidence that the combination of an alpha1-blocker with an anticholinergic extends physicians ability to manage lower urinary tract symptoms caused by bladder outlet obstruction and overactive bladder syndrome.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed2005

Sildenafil for the treatment of altitude-induced hypoxaemia.

Exposure to high altitude causes alveolar hypoxia and induces pulmonary hypertension (PH) with consequent limitation of exercise capacity. To assess the impact of sildenafil on haemodynamic and clinical parameters, and on aerobic performance, 12 young healthy unacclimatised subjects were studied (6 received sildenafil 40 mg t.i.d. and 6 received placebo) at sea level and high altitude. Systolic pulmonary artery pressure increased at high altitude, but normalised with sildenafil. The altitude-induced decrease in maximal O2 consumption was significantly smaller with sildenafil than with placebo. Enhancing pulmonary circulation with sildenafil safely protects against the high altitude-induced PH and improves gas exchange.

Altitude↗
PubMed2004

Clinical correlation of prostatic lithiasis with chronic pelvic pain syndromes in young adults.

OBJECTIVE: To investigate the incidence, morphology and clinical presentation of prostatic calculi in a selected population of young adults and to examine any possible correlation with chronic prostatitis/chronic pelvic pain syndromes (CP/CPPS). METHODS: A population of 1374 young adults was screened with ultrasound imaging of the prostate and 101 cases with prostatic lithiasis were selected. Patients were divided in two groups, according to the type of prostatic calculi (type A: small, multiple or type B: larger, coarser calculi). Further evaluation included history and physical examination, recording of lower urinary tract symptoms and the Meares-Stamey test. RESULTS: Calculi were type A in 71.3% and type B in 28.7% of cases. Localization (central/periurethral) was not correlated with other parameters. Age was closely related to calculus burden ( p =0.034 ). Type B calculi were more often associated with symptoms and chronic prostatitis/CPPS (chi(2)-test, p=0.007 and 0.018 respectively). CONCLUSIONS: Small, multiple calcifications are a normal, often incidental ultrasonographic finding in the prostate and represent a result of age rather than a pathologic entity. However, larger prostatic calculi may be related to underlying inflammation and require further evaluation and possibly, treatment.

Adult↗
PubMed2004

Ileal orthotopic bladder substitute combined with an afferent tubular segment: long-term upper urinary tract changes and voiding pattern.

OBJECTIVE: Assessment of the long-term morbidity of the upper urinary tract and of the voiding pattern in men with an ileal orthotopic bladder substitute with an afferent tubular segment. MATERIALS AND METHODS: Men surviving more than 5 years after radical cystectomy and orthotopic bladder substitution were evaluated. The urinary tract was regularly assessed with ultrasound and IVU while functional reservoir capacity and continence status were prospectively assessed by voiding volume diaries and a standardized questionnaire. RESULTS: After 5 years 129, after 10 years 45 and after 15 years 8 patients were evaluable. Median age at surgery was 63 years (range 36-80) and median follow-up was 73 months (range 60-201). Of the 254 renal units assessed between April 1985 and September 1998, 199 (78%) had some degree of dilatation in the 20-minute IVU film but rarely at 60 minutes. In 246 (97%) the parenchyma size was normal. Ureteral obstruction presented in 9 (3.5%) units, 4 of which were complete (3 had obstruction preoperatively and 1 postoperatively). Mean creatinine levels remained unchanged from the preoperative values. Functional reservoir capacity averaged 462 ml after 1 year, remained stable and then decreased slightly after 5 years. The daytime continence rate was 94% and 91% after 5 and 10 years, while the nighttime rate was 72% and 60% respectively. Patient age at the time of surgery was an important determinant for reservoir capacity and continence status. CONCLUSIONS: These data suggest that an orthotopic bladder substitution combined with an afferent tubular segment offers a sufficient protection of the upper tract with a low complication rate and has good long-term voiding and continence results. Meticulous lifelong follow-up is an important factor for satisfactory functional long-term outcome.

Aged↗
PubMed2004

Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution.

PURPOSE: We assessed factors influencing urinary continence and erectile function after radical cystoprostatectomy and ileal orthotopic bladder substitution. MATERIALS AND METHODS: Of 381 consecutive men undergoing radical cystoprostatectomy and ileal orthotopic bladder substitution between April 1985 and June 2003, 331 (87%) met the inclusion criteria and were enrolled in the analysis. Kaplan-Meier models and multivariate analysis applying Cox regression were used to evaluate factors influencing postoperative urinary continence and erectile function. RESULTS: In univariate analysis, attempted nerve sparing and age younger than 65 years were significantly associated with better daytime (p = 0.002 and p = 0.007, respectively) and nighttime continence (p = 0.036 and p = 0.005, respectively). In multivariate analysis the rate of daytime continence was significantly higher in patients with attempted nerve sparing (hazards ratio [HR] 1.4, 95% confidence interval [CI] 1.05-1.87) and nighttime continence was significantly better in patients younger than 65 years (HR 1.39, 95% CI 1.07-1.8). Daytime continence was significantly better (p <0.0001) and was achieved more quickly than nighttime continence (p <0.0001). The time to achieve daytime continence was shorter for patients with attempted nerve sparing (p = 0.012). In multivariate analysis erectile function recovered significantly more often in patients with attempted nerve sparing (HR 2.59, 95% CI 1.24-5.39) and in those younger than 65 years (HR 2.98, 95% CI 1.83-4.85). CONCLUSIONS: After radical cystoprostatectomy and ileal orthotopic bladder substitution, attempted nerve sparing and age younger than 65 years are associated with improved urinary continence. Attempted nerve sparing has the greatest impact on daytime continence and age has the greatest impact on nighttime continence. Attempted nerve sparing and younger age are both associated with more frequent recovery of erectile function.

Actuarial Analysis↗
PubMed2004

Postoperative management and rehabilitation of patients receiving an ileal orthotopic bladder substitution.

Ileal orthotopic bladder substitution has become one of the main therapeutic options following radical cystectomy for invasive bladder cancer. While careful patient selection and the surgical technique are necessary to obtain good long-term results and a satisfactory quality of life, postoperative management is also of utmost importance. It includes successful voiding rehabilitation (micturition technique, complete bladder emptying, increase of functional reservoir capacity, and sphincter training) and a meticulous lifelong followup.

Acidosis↗
PubMed2003

Carcinosarcoma of the ureter: a rare, pleomorphic, aggressive malignancy.

AIM: To examine histological nature and clinical process of ureteral carcinosarcomas. METHODS: We report on a new case of carcinosarcoma of the ureter. The literature was reviewed and histological and clinical features were elucidated. RESULTS: Fourteen cases of ureteral carcinosarcomas have been reported. The nomenclature used for these tumors either in the pathology reports or in literature is confusing. In contrary to obscure tumor biology, prognosis was clearly bad as the majority of the patients died within 2 years after diagnosis. CONCLUSIONS: Terminology confusion is due to the rarity of this entity and lack of its biology knowledge. Patients present after the age of 60 with hematuria and obstruction. Nephroureterectomy is the only hope of cure but, due to tumor aggressiveness, recurrences occur almost always and prognosis is poor.

Aged↗
PubMed2002

Effects of finasteride and cyproterone acetate on hematuria associated with benign prostatic hyperplasia: a prospective, randomized, controlled study.

OBJECTIVES: To evaluate the influence of two differently acting antiandrogens, finasteride (FIN) and cyproterone acetate (CPA), on the natural history of hematuria associated with benign prostatic hyperplasia (BPH) in a prospective, randomized, controlled study. METHODS: Forty-two patients with hematuria episodes due to BPH were randomly allocated to three subgroups of 14 patients each and treated daily with either 5 mg FIN or 100 mg CPA or were placed in a watchful waiting arm. Patients were evaluated at 3-month intervals, and 40 patients had at least 1 year of follow-up. RESULTS: Four patients in the FIN group (30%) and three in the CPA group (23%) presented with recurrent hematuria. In both groups, the bleeding episodes were treated conservatively and required no hospitalization. In the control group, 8 patients (57%) presented with recurrent bleeding; in 4, the bleeding was severe and required some form of intervention (catheterization or transurethral prostatectomy). When the frequency and severity of the hematuria episodes were analyzed over time, a statistically significant difference for FIN versus control was present at 9 and 12 months (analysis of variance, P = 0.035 and P = 0.009, respectively). A similar difference was evident for CPA versus control at 9 and 12 months (P = 0.028 and P = 0.008, respectively). No statistically significant difference was present between the FIN and CPA groups. Interestingly, no statistically significant effect in bleeding recurrence for both CPA and FIN over controls was present at 3 and 6 months of follow-up. CONCLUSIONS: Both FIN and CPA seem to exert a comparable control in hematuria recurrence in patients with BPH, thus confirming the rationale behind the use of antiandrogens for such a purpose. Our results support the hypothesis that any antiandrogen, irrespective of the mode of action, would alter the natural history of BPH-associated hematuria. Interestingly, our results indicate that the speed of action of FIN may not be as rapid as previously described.

Aged↗
PubMed2002

Externally coated ureteral metallic stents: an unfavorable clinical experience.

OBJECTIVE: The purpose of the present study was to evaluate the use of externally coated stents in patients with malignant ureteral obstruction. MATERIALS AND METHODS: We have prospectively evaluated 16 patients, 10 men and 6 women, with malignant ureteral obstruction treated successfully by placement of Passager metal stents (Boston Scientific, Natick, MA, USA) bypassing the stricture. Mean patient age was 65.6 years (range 62-78 years). Ureteral patency was confirmed 24 and 48 hours by injection of contrast material through the nephrostomy tube, and after patency confirmation the nephrostomy catheter was removed. RESULTS: All stents were positioned successfully, and the postoperative course was uneventful. In 13 cases (81.2%) the prostheses finally migrated into the bladder hindering overall ureteral patency (mean time of migration: 1.5 months). Patency was achieved in the remaining ureters (n=3), during the follow-up period (mean: 8 months, range 6-16 months), without any need for further intervention. CONCLUSION: The inappropriate anchorage and the increased ureteral peristalsis are the main causes of migration towards the bladder, thus, minimizing the usefulness of this stent for the treatment of ureteral strictures.

Aged↗