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Biomedical subjects

T E Pavlidis

Publications and source records attributed to T E Pavlidis.

13 recordsLinked to original sources
PubMed2006

Intraperitoneal ePTFE mesh repair of parastomal hernias.

Parastomal hernia represents a common complication of colostomy formation. Surgical techniques such as facial repair and stoma relocation have almost been abandoned because of high recurrence rates. Extraperitoneal prosthetic mesh repair had better results but was accompanied by high rates of mesh contamination. A new technique, with intraperitoneal onlay position of expanded polytetrafluoroethylene (ePTFE) was therefore established. We report herein two cases of symptomatic large parastomal hernias treated in our department.

Colostomy↗
PubMed2006

Safety of bowel resection for colorectal surgical emergency in the elderly.

OBJECTIVE: Colorectal emergency requiring radical surgery is becoming increasingly frequent in the elderly and problems remain as regards the best management policy. Our long-time experience is presented in this study. PATIENTS AND METHODS: In the last 23 years, 105 elderly patients, aged > or = 65 years, with colorectal disease underwent an emergency operation in our Surgical Department. Forty-five patients (mean age 72 years) had benign disease and 60 patients (mean age 76.5 years) colorectal carcinoma. RESULTS: The carcinoma was located in the left colon (68%), right colon (18%) and rectum (14%). Mostly, patients with malignant cancer presented with obstructive ileus, and patients with benign tumours with perforation and peritonitis, with a predominance of diverticulitis. A resection operation either with primary anastomosis or Hartmann's procedure was performed in 75% of cases; in the rest, only palliation was resorted to. Forty-three percent of the patients with colorectal cancer emergency were > or = 80 years of age. The mean morbidity was 25% and mortality 17%, which make up to 33% and 26.6% for benign disease, and 20% and 10% for malignant cancer, respectively. The mortality rate was higher in patients with perforation than those with obstruction. CONCLUSION: Advanced age is not a contraindication to radical surgery in case of colorectal emergency in the elderly. In the majority, a resection operation is feasible. In high-risk patients, colostomy is a life-saving alternative.

Adenocarcinoma↗
PubMed2005

Recurrence and long-term outcome after open cystectomy with omentoplasty for hepatic hydatid disease in an endemic area.

BACKGROUND/PURPOSE: Surgery is the cornerstone in the treatment of echinococcosis. The purpose of this study is to report the long-term results of partial cystectomy and omentoplasty in the management of hepatic hydatid disease. MATERIAL AND METHODS: In a retrospective survey over the past 20 years (1982-2001) there were 36 patients (13 men and 23 women, with a mean age of 50 years) with hepatic echinococcosis, treated by partial cystectomy and omentoplasty. All patient data were carefully studied and short-term as well as long-term results were assessed. The cystic lesion was single in all but two cases (5.6%), located in the right lobe of the liver (69.4%), the left lobe (25%) or both lobes (5.6%). The mean size of the cyst was 12 cm in diameter (range 3 to 25 cm). The follow-up was achieved at regular intervals and recently in all, including computed tomography and specific immunological test ELIZA. It has completed a mean 12-year period (range 2 to 21 years) and in 75% of cases up to 10 years. RESULTS: The mean hospital stay was 23 days (range 9 to 51 days). The morbitity was 8/36 (22%) due mainly to septic complications. The 30-day mortality was 1/36 (2.7%). The residual cavity remained for a mean of 8 months (range 4 to 18 months), while fistula formation was seen in 1/36 (2.7%). There was cure in 29 cases (80.6%) without any serological or imaging evidence of residual disease. However, recurrence was documented in 7 cases (19.4%) requiring further treatment. CONCLUSIONS: Following the experience of the authors, partial cystectomy and omentoplasty may be an acceptable alternative to more radical procedures, especially in high risk cases and in developing countries.

Adult↗
PubMed2003

Cellular changes in association with defense mechanisms in intra-abdominal sepsis.

Despite progress, intra-abdominal sepsis is associated with a high morbitity and mortality rate. Although, much effort has been made in basic research, there have not been any therapeutic applications as yet. The peritoneal defense system (innate and specific) represents the first local reaction to inflammation caused by bacterial invasion. It includes lymphatic absorption of bacteria, phagocytosis, entrenchment of inflammation and lymphocyte production (humoral and cellular immune). Also, the fibrin formation and degradation by intraperitoneal activation of coagulation and fibrinolysis plays an important role in this local response. The endotoxin from Gram-negative or exotoxins from Gram-positive bacteria cause the release of proinflammatory cytokines (TNF-alpha, IL-1betha, IL-6) by macrophages. They act as mediators resulting in the initiation of systemic inflammatory response syndrome (SIRS) at first and cellular damage with multiple organ dysfunction syndrome (MODS) ultimately. There are two different, but communicated, functional departments, i.e. peritoneal and systemic compromising the host inflammatory response to bacterial infection. Cytokine production occurs in both of them.

Abdomen↗
PubMed2002

Helicobacter pylori infection in patients undergoing appendectomy.

AIMS: Helicobacter pylori has been found in the upper gastrointestinal tract; it is incriminated as aetiological factor in various pathological conditions. This prospective study assesses the presence of this microorganism in the appendix flora and the possible role of its infection in the pathogenesis of acute appendicitis. METHODS: H. pylori was investigated in 46 consecutive patients undergoing emergent appendectomy for presumed acute appendicitis. Blood sample for serological test of H. pylori infection was drawn before operation. The removed appendix specimen was stained for H. pylori; confirmation was made by PCR (Polymerase Chain Reaction) analysis. The intensity of inflammation was determined pathologically grading from no inflammation to gangrenous appendicitis. Statistical analysis was made using the chi-square test. RESULTS: Seropositivity for H. pylori infection was found in 18 patients (39%), but the microbe was detected in just two appendix specimens (4%). In all seropositive patients acute appendicitis was confirmed by the pathology study; serous (33%) and purulent or gangrenous (67%). The latter incidence in the seronegative patients was 50%. There were found eight specimens (17%) negative for inflammation dealing all with seronegative patients. CONCLUSIONS: It seems that H. pylori colonizes the appendix in small proportion and is unlikely to be associated in direct correlation with acute appendicitis. However, seropositive patients with acute inflammation are likely to suffer from purulent or gangrenous form.

Acute Disease↗
PubMed2002

Comparison between modern mesh and conventional non-mesh methods of inguinal hernia repair.

BACKGROUND: The objectives of the study were to compare the tension-free mesh repair with non-meash conventional repair of groin hernia. METHODS: In the past two years in 299 consecutive unselected patients 339 inguinal hernia repairs were carried out. They randomly allocated to undergo either a non-meash modified Bassini's repair (n=164) or a tension-free mesh repair (n=175). The latter group consisted of laparoscopic TAPP repair (n=46) and open onlay patch repair (n=64) or plug and patch repair (n=65). Operation time, postoperative pain and complications, hospital stay, return to work and recurrence were assessed. Statistical analysis was made using the "t"-Student test. RESULTS: The characteristics of the patients in each group and the operation time did not differ significantly. The planned procedure was completed in all and no death occurred. The analgesic requirements (none 2.5 vs 56.4%, opiods 77 vs 23.6%), complication rate (9.4 vs 4.3%), hospital stay (4.2 vs 1.8 days), return to work (17.2 vs 7.3 days) and recurrence rate (5.5 vs 1.2%) in non-mesh group were more than in the mesh group. All differences were statistically significant (p<0.05). Among the three subgroups of mesh group no statistically significant differences (p>0.05) were found. CONCLUSIONS: The tension-free mesh repair either open or laparoscopic provides excellent results with better short-term outcome and lower recurrence rate than non-mesh modified Bassini's repair.

Adolescent↗
PubMed2001

Abdominal wall sinus due to impacting gallstone during laparoscopic cholecystectomy: an unusual complication.

During laparoscopic cholecystectomy, perforation of the gallbladder can occurs in < or = 20% of cases, while gallstone spillage occurs in < or = 6% of cases. In most cases, there are no consequences. Gallstones can be lost in the abdominal wall as well as the abdomen during extraction of the gallbladder. The fate of such lost gallstones, which can lead to the formation of an abscess, an abdominal wall mass, or a persistent sinus, has not been studied adequately. Herein we report the case of a persistent sinus of the abdominal wall after an emergent laparoscopic cholecystectomy in an 82-year-old woman with gangrenous cholecystitis and perforation of the friable wall in association with an empyema of the gallbladder. The culture of the obtained pus was positive for Escherichia coli. After a small leak of dirty fluid from the wound of the epigastric port site of 4 months' duration, surgical exploration under local anesthesia revealed that the sinus was caused by spilled gallstones impacting into the abdominal wall between the posterior sheath and left rectus abdominalis muscle. The removal of the stones resulted in complete healing. Long-term complications after laparoscopic cholecystectomy involving the abdominal wall are rare but important possible consequences that could be avoided.

Abdominal Abscess↗
PubMed2001

Complete dehiscence of the abdominal wound and incriminating factors.

OBJECTIVE: To find out the causes of abdominal wound dehiscence. DESIGN: Retrospective study. SETTING: University hospital, Greece. SUBJECTS: Abdominal wound dehiscence occurred in 89 cases out of 19,206 major abdominal operations including 4671 emergencies during the past 15 years (0.5%). INTERVENTIONS: In the study group 14 local and systemic risk factors were analysed and compared with those in a control group of 89 patients who had similar procedures without dehiscence. MAIN OUTCOME MEASURES: Statistical analysis using the chi square test. RESULTS: Significant factors (p < 0.05) included age over 65 years, emergency operation, cancer, haemodynamic instability, intra-abdominal sepsis, wound infection, hypoalbuminaemia, ascites, obesity, and steroids. Risk factors that were not significant included sex, anaemia, diabetes mellitus and pulmonary disease. Overall morbidity and mortality were 30% and 16%, respectively. The mortality and the possibility of dehiscence seem to correlate directly with the number of risk factors. CONCLUSION: Patients with these risk factors require more attention and special care to minimise the risk of its occurrence.

Aged↗
PubMed2001

Laparoscopic Nissen fundoplication.

Open Nissen fundoplication has been established as an effective treatment in the management of gastroesophageal reflux disease (GORD). Progress in minimally invasive surgery has given the chance of performing laparoscopic Nissen fundoplication. The short-term results are encouraging and its outcome promising. The need for long-term medication ceases and it has already widely replaced the open procedure. Furthermore, the laparoscopic procedure can achieve the repair of any hiatal defect present. Thorough preoperative evaluation is imperative, because it determines the indication for surgery as well as the sort of operation. The laparoscopic procedure ensures a meticulous dissection and full mobilization of the lower oesophagus. These preconditions are of great importance in performing safely a floppy wrap. The method could be followed by complications or failure. Appropriately designed modern equipment is necessary. Thus, much experience and adequate training are required for the perfect application of laparoscopic Nissen fundoplication.

Fundoplication↗