Biomedical subjects

V Smyrniotis

Publications and source records attributed to V Smyrniotis.

At least 19 recordsLinked to original sources

PubMed2006

The effect of acutely induced hepatic failure on remifentanil and fentanyl blood levels in a pig model.

BACKGROUND AND OBJECTIVE: Opioids and especially fentanyl are widely used during the intensive care unit management of intracranial pressure in fulminant hepatic failure patients as well as during and after liver transplantation. The newer synthetic opioid remifentanil is also increasingly being used in critical care patients. Due to a lack of data relating to the influence of acute hepatic failure on remifentanil and fentanyl pharmacokinetics, this study was designed in order to determine the impact of this condition on the blood levels of these opioids using a pig model. METHODS: Twenty pigs were randomly assigned to one of two groups: A group with surgically induced acute hepatic failure by hepatic devascularization (acute hepatic failure, n=10) and a control group (SHAM, n=10), subjected to a SHAM operation. Postoperatively, five animals in each group were administered remifentanil (1 microg kg-1 min-1) or fentanyl (0.2 microg kg-1 min-1) by continuous intravenous infusion. Blood samples for determination of drug concentrations were withdrawn at 0 h and 0.5, 1, 5, 7, 9 h after initiation of dosing. RESULTS: Significantly higher blood concentrations were found in animals with acute hepatic failure compared to SHAM-operated animals receiving remifentanil at 5 h (P=0.003), 7 h (P=0.007) and 9 h (P=0.004) and fentanyl at 7 h (P<0.0005) and 9 h (P=0.05). The small number and the great variability in drug concentrations did not allow a detailed kinetic analysis to be performed. Approximate clearance values were found to be greater for the SHAM compared with the acute hepatic failure animals for both fentanyl and remifentanil. CONCLUSIONS: Hepatic devascularization in our porcine acute hepatic failure model, appears to have significantly altered the disposition of fentanyl and unexpectedly remifentanil. These changes were thought to be brought about by severe disruption of blood flow and biotransformation in the liver, as well as by haemodynamic changes in the acute hepatic failure animals.

Acute Disease↗

PubMed2006

Urgent thyroidectomy for acute airway obstruction caused by a goiter in a euthyroid pregnant woman.

Pregnancy constitutes a significant factor for thyroid enlargement. However, acute respiratory failure as a result of airway obstruction from an enlarged thyroid gland is an unusual incident. The case presented here concerns a 27-year-old black woman in her 20th gestational week who underwent an urgent operation for removal of a nontoxic, multinodular, mildly substernal goiter that was causing severe upper airway obstruction leading to acute life-threatening respiratory failure. Diagnosis of an extrathoracic tracheal stenosis was based on spirometry with analysis of the flow volume curve and was confirmed by magnetic resonance imaging of the neck. Despite operational risks to the mother as well as the fetus during gestation, an urgent thyroidectomy was carried out successfully. The postoperative period progressed normally and the patient completed her pregnancy with no further respiratory symptoms.

Adult↗

PubMed2006

Secondary tumors of the intestines in females: a retrospective clinicopathologic study of seven cases.

OBJECTIVE: To investigate the primary site and the pathological features of secondary intestinal tumors in females, with emphasis on their differential diagnosis from primary neoplasms of the intestines. METHODS: Seven cases of secondary intestinal tumors in females were retrieved from the archival files of our laboratory. The relative clinical data were also reviewed. Inmmunohistochemistry was performed in cases with diagnostic difficulties. RESULTS: The primary site of the tumor was defined as follows: the ovary (ovarian adenocarcinoma) in five cases (71.4%), the skin (cutaneous malignant melanoma) in one case (14.28%) and the uterine corpus (mixed mullerian tumor) in one case (14.28%). In two cases the primary site was not determined initially, but the investigation showed that the primary tumor was ovarian in origin. In five cases the existence of a primary tumor was already known. Immunohistochemistry was applied in three cases for confirmation of the suspected primary tumor by histological examination. CONCLUSION: Histological diagnosis of secondary intestinal tumors may be extremely difficult, especially when the primary site is not previously known, and because of the tendency of certain secondary tumors to mimic, both grossly and microscopically, the primary ones. Immunohistochemistry is extremely helpful in resolving these diagnostic difficulties.

Adenocarcinoma↗

PubMed2006

Endometriosis mimicking soft tissue tumors: diagnosis and treatment.

The clinical manifestations, the radiologic appearance and the treatment of four women with extragenital endometriosis of the abdominal wall are presented. In two patients endometriosis was found adherent with the structures of the inguinal canal and in the other two the tumors infiltrated structures of the abdominal wall. Symptoms included cyclical pain and palpable subcutaneous masses fixed to the surrounding tissues. Computed tomography and magnetic resonance imaging failed to differentiate the lesions from other soft tissue tumors. Resection to healthy tissue margins is the treatment of choice, in order to avoid local recurrence.

Adult↗

PubMed2006

Clinicopathological features of unusual vascular lesions of the pelvis, retroperitoneum and colon in females: a report of five cases and review of the literature.

Vascular lesions comprise benign and malignant neoplasms as well as non-neoplastic conditions that may be located in various sites but only rarely in the pelvis or the retroperitoneum. In our study we describe five diverse and unusual cases of vascular lesions of the pelvis, retroperitoneum and colon in female patients: a case of retroperitoneal angiosarcoma, pelvic hemangioendothelioma, pelvic angiomyxoma, retroperitoneal lymphangioleiomyomatosis and a case of diffuse cavernous hemangiomatosis of the colon, with emphasis on their clinicopathological features and differential diagnosis. The recent literature on the subject is also briefly reviewed.

Adult↗

PubMed2006

Colorectal cancer emergencies during pregnancy case reports.

Colorectal carcinoma emergencies during pregnancy are exceptionally rare. Three women 38, 31 and 36 years old, in the third trimester of gestation received treatment, respectively, for acute abdomen due to perforation of rectal carcinoma, ileus due to a sigmoid tumor, and deep venous thrombosis (DVT) from a cecal tumor compromising the right iliac vein. In the first two patients urgent cesarean sections were carried out with Hartmann's procedure and a loop colostomy was performed to resolve the ensuing intraabdominal sepsis and ileus, respectively. In the third patient, a cesarean section was carried out to treat the underlying DVT more aggressively, while right colectomy was postponed for three weeks. Restoration of the alimentary tract was achieved two months later in the first case, while in the second and third cases total colectomy due to familial polyposis and right colectomy were performed three weeks after the cesarean section. An overview of the clinical features, diagnostic pitfalls and therapeutic approaches to manage complications of colorectal cancer during pregnancy are discussed.

Abdominal Pain↗

PubMed2006

Incidental finding of a malignant peritoneal mesothelioma in an inguinal hernia sac: report of a case.

We report the case of a 46-year-old female who underwent a routine operation of herniorraphy for a right inguinal hernia. Physical findings revealed a moveable tender mass in the right lower inguinal area. Pathological examination revealed a mass with multiple nodules scattered in the inguinal hernia sac. The histological features of these nodules were compatible with malignant peritoneal mesothelioma (MPM). The incidental finding of MPM in the inguinal hernia sac is very rare. The incidence of this neoplasm is 2-2.6 cases per million annually, and the prognosis is very poor.

Female↗

PubMed2005

Effects of dopexamine on lipid peroxidation during aortic surgery in pigs: comparison with dopamine.

OBJECTIVE: We investigated the dose-related effect of dopexamine and dopamine on free radical production and lipid peroxidation estimated by MDA measurements in an ischaemia-reperfusion model of supraceliac aortic repair. DESIGN: Prospective, randomized, blinded experimental study. MATERIALS: Twenty-five healthy pigs. METHODS: All experiments were performed under general endotracheal anaesthesia. Supraceliac aortic cross clamping was performed in all pigs. The pigs were randomly assigned into five groups (n=5 in each group) and received a continuous intravenous infusion of normal saline (CTL), dopamine 2 microg kg(-1)min(-1) (dopa 2), dopamine 8 microg kg(-1)min(-1) (dopa 8), dopexamine 2 microg kg(-1)min(-1) (dopex 2), dopexamine 8 microg kg(-1)min(-1) (dopex 8). Cardiac output, mean arterial pressure, arterial blood gas analysis and blood sampling for plasma MDA measurements (to reveal lipid peroxidation) were recorded after induction of anaesthesia (baseline), 60 and 120 min after cross-clamping of aorta (ischaemia phase), and 60 and 120 min after restoration of flow (reperfusion phase). RESULTS: Dopexamine and dopamine at 8 microgkg(-1)min(-1) reduced MDA at 60 and 120 min after reperfusion. CONCLUSION: Dopexamine seems superior to dopamine in reducing oxygen free radicals and subsequent lipid peroxidation during reperfusion after supraceliac aortic cross clamping in pigs.

Animals↗

PubMed2005

Extragenital cystic lesions of peritoneum, mesentery and retroperitoneum of the female. Clinicopathological characteristics of 19 cases.

The clinicopathological characteristics are presented of 19 extragenital cystic lesions of female patients located at the retroperitoneum (9 cases), the mesentery (6 cases) and the peritoneum (4 cases). Median age was 42.3 years and the main symptom was abdominal pain. The cysts measured 4-27 cm in diameter and were classified as: epithelial (7/19), mesothelial (5/19), vascular (2/19), parasitic (1/19) and developmental in origin (4/19). Of the cases 18/19 were benign lesions and one case was a borderline mucinous cystic tumor. Immunohistochemistry by a streptavidin-biotin method was performed to investigate CEA transcripts (MoAb, Novosan), CA125 (MoAb, CIS Diagnostics), vimentin (MoAb Ve6, Novocastra), secretory component (a polyclonal antibody, DAKO), Factor VIII (MoAb, DAKO), CD34 (MoAb, Scytec), calretinin (a polyclonal antibody, Zymed, San Francisco, CA). Cytokeratins were of low and high molecular weight (Immunon, AE1-MoAb). The results are helpful in the correct classification of various tumors. The treatment of choice is complete surgical resection of the tumors.

Adult↗

PubMed2004

Clinicopathological study of vascular tumors of the breast: a series of ten patients with a long follow-up.

Ten cases of vascular tumors of the breast were examined in our laboratory during the last decade (1992-2001). Nine patients were female and one male (ages 31-77, average 52 years). Six patients presented parenchymal vascular lesions (1 angiosarcoma, 1 atypical hemangioma, 3 perilobular hemangiomas, 1 cavernous hemangioma) measuring 0.5-6 cm in the greatest diameter. Two lesions were accidental findings in lumpectomy specimens excised for fibrocystic disease with microcalcifications. Four patients presented non-parenchymal vascular lesions: three cavermous hemangiomas (one in a male patient) and one angiolipoma measuring 1-6 cm in diameter. All tumors were treated by lumpectomy with the exception of the atypical hemangioma which was treated by simple mastectomy. The patient with the angiosarcoma was treated by simple mastectomy, radiotherapy and chemotherapy and died with disseminated disease three years after initial diagnosis. All other patients are well up to date (follow-up 1-9 years).

Adult↗

PubMed2004

Extraovarian mullerian-type cystic tumors of the female. A report of six cases and review of the literature.

Six cases of extraovarian cystic tumors of mullerian type are reported. Patient age ranged from 27-71 years. Tumor diameters were 5-11 cm and were located in the mesentery (4/6) and retroperitoneum (2/6). Four tumors were of mucinous type (1/4 of borderline malignancy) and two of serous type. These tumors clinically and histopathologically mimic other primary tumors of the peritoneum. The problems of differential diagnosis are discussed.

Abdominal Neoplasms↗

PubMed2004

Malignant neoplasms arising in endometriosis: clinicopathological study of 14 cases.

During the last 15-year period in our laboratory, 14 cases of malignant change of endometriosis were diagnosed in women 37-70 years of age. Seven cases were adenocarcinomas, one case was an adenosarcoma and six cases presented the morphology of endometrial stromal sarcoma. Eleven cases developed in various sites of the genital system (5/11 in the ovaries, 3/11 in the uterus 2/11 in the vagina, 1/11 in the tubal wall) and three cases in extragenital sites (1/3 in the omentum, 1/3 in the pelvis, 1/3 in the colon). Immunohistochemical investigation for the expression of cytokeratines, vimentin, hormonal receptors, E-cadherin, desmine and smooth muscle actin was performed by a streptavidin-biotin method. The immunopathology profile and follow-up results after therapy are presented.

Adenocarcinoma↗

PubMed2003

Surgical adjuvant therapy of rectal carcinoma: a controlled evaluation of leucovorin, 5-fluorouracil and radiation therapy with or without interferon-alpha2b.

BACKGROUND: The aim of this study was to determine whether the efficacy of the combination of 5-fluorouracil (5-FU), leucovorin (LV) and radiation therapy (RT) could be improved by the addition of interferon-alpha2b (IFN-alpha) in patients who have had a 'curative' resection, for rectal adenocarcinoma (Dukes' B2/C; T3 N0, T4 N0, N1-3). PATIENTS AND METHODS: A total of 207 eligible patients with a performance status of 0 or 1 were randomized postoperatively between days 21 and 70 to one of the two treatment groups: group A, LV 20 mg/m2 i.v. bolus and 5-FU 425 mg/m2 i.v. days 1-5 and 29-33, LV 20 mg/m2 and 5-FU 400 mg/m2 days 57-60 and 85-88, LV 20 mg/m2 and 5-FU 380 mg/m2 days 1-5 and 29-33 with the second day 1 occurring 28 days after the completion of RT (45 Gy); group B, LV, 5-FU and RT as in group A, and IFN-alpha 5 x 10(6) IU s.c. three times during each week chemotherapy is given. RESULTS: 104 patients were randomized into group A and 103 into group B. There was no statistically significant difference in either disease-free survival or overall survival between the two groups. Toxicity was also the same, except for the flu-like syndrome associated with the IFN-alpha administration. CONCLUSIONS: There was no difference in efficacy between the two combinations. Toxicity was greater with the LV + 5-FU + IFN-alpha regimen because of the flu-like syndrome.

Adenocarcinoma↗

PubMed2003

Immunopathological study of mesonephric lesions of cervix uteri and vagina.

Seventeen cases of mesonephric cervical remnants, four cases of mesonephric cervical carcinoma and nine vaginal Gardner cysts were studied by histochemical and immunohistochemical methods for the presence of mucin, proteoglucans, glucogen, CEA, cytokeratins, secretory component and vimentin. Mesonephric lesions in contrast to endocervical glandular lesions are negative for mucin, glucogen, CEA, and secretory component and positive for vimentin, and broad spectrum cytokeratins. Mesonephric carcinomas present certain immunopathological characteristics that permit their identification and proper treatment.

Adenocarcinoma↗

PubMed2003

A safe method of gut resection in women with complicated post-radiation enteritis after cervix cancer.

BACKGROUND: Resection of the irradiated gut in women with cervical cancer is complicated by high morbidity and mortality mainly due to accidental injuries to the adjacent intrapelvic structures. To eliminate these injuries a new method is proposed. METHOD: Six patients between 41 and 56 years old who had received radiation therapy for cervical cancer were operated on for post-radiation injury of the terminal ileum. All patients underwent partial resection of the irradiated small bowel plus right colectomy. The surgical technique was undertaken so as to leave parts of the small bowel (20 to 45 cm) adherent to the adjacent organs when complete resection was judged precarious. RESULTS: All patients had an uneventful recovery with 6 to 14 days hospitalization. No complications related to the remaining intrabdominal parts of the gut were observed. All patients died of the primary disease over 1 to 5 years postoperatively. CONCLUSION: The method is safe, simple and eliminates injuries to the adjacent structures.

Adult↗

PubMed2002

Haemodynamic changes in ischaemic vs. anhepatic pig experimental model of acute liver failure.

BACKGROUND AND OBJECTIVE: The removal of the non-functioning liver in cases of fulminant liver failure has been advocated by some authors as a means of improving haemodynamic instability and acid-base disturbances associated with acute liver failure. METHODS: The aim of the present experimental study was to investigate whether maintaining a non-functioning liver is preferable over removing it in terms of haemodynamic variables, after acute hepatic failure has been surgically induced. Twenty Landrace pigs were used in the study. All of them underwent portocaval anastomosis and ligation of the hepatic artery. After an 18-h period and with biochemical indices of fulminant hepatic failure clearly demonstrated, the animals were randomly assigned to one of two groups: in 10 pigs (Group A) the ischaemic liver was left in situ and no further surgical intervention was undertaken. The other 10 (Group B) underwent total hepatectomy. Haemodynamic monitoring was the same in both groups. No inotropes were administered throughout the whole period of observation. RESULTS: Haemodynamic deterioration was observed in the hepatectomized pigs (Group B) whereas the group with the ischaemic liver in situ (Group A) remained stable in terms of the haemodynamic variables evaluated until the end of the experiment. (Cardiac index in Group A 7.59 +/- 1.25 L min(-1) m(-2) vs. 2.92 +/- 0.68 L min(-1) m(-2) in Group B, P < 0.05.) CONCLUSIONS: The concept of salvage hepatectomy in cases of acute liver failure should be redefined since there seems to be some experimental evidence that it may not be as beneficial as originally thought.

Analysis of Variance↗

PubMed2001

Diagnostic efficacy and safety of MRI of the liver with superparamagnetic iron oxide particles (SH U 555 A).

The purpose of this study was to evaluate the diagnostic efficacy and safety of an intravenous injection of magnetic resonance imaging (MRI) contrast agent, SH U 555 A, in adult patients with known focal liver lesions. Pre- and post-contrast image sets were obtained in 19 patients after injection of SH U 555 A as a part of a phase III clinical trial (patients <60 kg body weight received 0.9 mL and patients >60 kg received 1.4 mL). Three blinded readers evaluated the post-contrast images. Blood pressure and heart rate were recorded and laboratory tests were performed at baseline, during and immediately after the procedure, and four and 24 hours after the MR procedure. On post-contrast MRI, there was statistically significant improvement in diagnostic confidence, visualization, delineation, and contrast between the lesions and the healthy parenchyma in comparison to precontrast. Twenty more lesions were detected on post-contrast images. The management in six patients (31.7%) was changed after post-contrast imaging. Changes in vital signs and laboratory tests were minimal and did not affect the patients' clinical condition. Only a moderate allergic reaction (diffuse erythematous rash) was recorded. SH U 555 A is an effective and safe contrast agent for MRI of the liver.

Contrast Media↗

PubMed2001

Focal nodular hyperplasia: imaging findings.

Focal nodular hyperplasia is an uncommon benign hepatic tumor that continues to pose diagnostic dilemmas. Imaging techniques are of great value in diagnosis of this tumor. In this article we present the US, CT, MR imaging, scintigraphy, and angiography findings. The demonstration of a central vascular scar is very helpful. Although the radiologic features may be diagnostic, many atypical cases must be differentiated from other benign or malignant hepatic tumors. In these cases excisional biopsy and histopathologic examination are necessary to determine a definite diagnosis.

Angiography↗