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V Smyrniotis

Publications and source records attributed to V Smyrniotis.

At least 37 records · Page 2Linked to original sources
PubMed2001

Small-bowel herniation under the infrarenal arterial conduit in a liver transplant recipient.

We report a case of herniation of the entire small bowel under an infrarenal conduit 8 months after orthotopic liver transplantation. The conduit was compressed by the mesentery and developed a stricture and thrombosis. Liver revascularization was accomplished by an urgent thrombectomy, resection of the stricture, and reanastomosis of the conduit. Suspicion of this serious complication should arise in transplant recipients who present with bowel obstruction associated with liver dysfunction.

Adolescent↗
PubMed2001

Tailgut cysts: a rare cause of pelvic outlet obstruction.

Tailgut cysts are unusual cystic tumors of the retrorectal space. We describe the findings of three cases. Constipation, intrapelvic fullness and low abdominal pain were the most prominent clinical manifestations. One patient developed an abscess. Ultrasound, computed tomography and MR imaging demonstrated the presacral lesions. Transabdominal excision of the tumors in two patients resulted in good outcome whereas in the patient with the abscess there was recurrence with a fistula formation.

Abdominal Pain↗
PubMed2000

Severe hypothyroidism in patients dependent on prolonged thyroxine infusion through a jejunostomy.

BACKGROUND AND AIMS: Enteral absorption of thyroxine (T4) is variable; the duodenum and jejunum appear to be the most important sites of absorption. Our objective is to demonstrate that T4 infused via a standard jejunostomy may occasionally be poorly absorbed. METHODS: Two patients underwent esophagolaryngeal resection for carcinoma of the cervical esophagus. The procedure was accompanied by complete removal of the thyroid and parathyroid glands. A neck fistula at the gastropharyngeal anastomosis led to a restriction of oral intake; daily requirements of T4 and nutrients were given via the jejunostomy. T4 plasma levels deteriorated and thyroid-stimulating hormone (TSH) levels increased and in the third postoperative week, T4 (300 microg) was administered via a nasogastric tube. RESULTS: Although given a high dose (300 microg) of T4, both patients developed severe hypothyroidism. Infusion of T4 through the nasogastric tube precipitated the normalization of T4 and TSH plasma levels. Both patients (cases 1 and 2) resumed oral intake during the fifth and sixth postoperative weeks respectively. CONCLUSION: T4 malabsorption may occur in patients dependent on prolonged T4 infusion via a standard jejunostomy.

Aged↗
PubMed2000

Immunohistochemical study of ceruloplasmin, lactoferrin and secretory component expression in neoplastic and non-neoplastic thyroid gland diseases.

The expression of lactoferrin (LF), ceruloplasmin (CP) and secretory component (SC) in various thyroid diseases was investigated using an immunohistochemical method. LF is an iron-binding protein overexpressed in certain human adenocarcinomas. CP is implicated in carcinogenesis and SC is part of the local immune defense system. Sections of 15 follicular adenomas, 5 follicular carcinomas (FC), 16 papillary carcinomas (PC), 15 goitres and 2 cases of lymphocytic thyroiditis were re-examined and investigated immunohistologically by a streptavidin-biotin method. A positive immunostain reaction for CP and LF was observed in all cases of PC and FC. A positive immunostain reaction for SC was observed in 13/16 cases of PC and 4/5 cases of FC. A negative immunostain reaction for CP, LF and SC was observed in medullary cancers, in follicular adenomas and in the cases with goitre. We conclude that the immunostain expression of LF, CP and SC is a valuable diagnostic aid in the differential diagnosis between benign and malignant thyroid tumors. The expression of SC indicates the presence of a local immunodefensive system.

Adenocarcinoma, Follicular↗
PubMed2000

Splenic abscess. An old disease with new interest.

BACKGROUND/AIMS: To study the demographics, signs and symptoms, causes, risk factors, imaging findings, bacteriologic profile, treatment and outcome of patients with splenic abscess. METHOD: The medical records of 17 patients with splenic abscess at two tertiary-care hospitals between 1989 and 1997 were retrospectively reviewed. The demographic data, physical and radiological findings, treatment, bacteriology reports and outcome of treatment were reviewed. RESULTS: The mean age of patients was 43 years (range 7-79 years). Fever and abdominal pain were the most prominent signs. Seven patients were immunocompromised, three had abscessed hydatic cysts, two were drug users and three suffered from splenic trauma, infarction, and endocarditis, respectively. No predisposing factor was identified in 2 patients. In all cases, CT demonstrated the splenic lesion(s). Staphylococcus species and Bacteriodes were the most common microbes, identified in the blood and abscess cultures. Thirteen patients underwent splenectomy, two medical therapy and two no therapy with respective survival rates of 92, 100 and 0%. CONCLUSION: Splenic abscess is a rare surgical entity encountered mostly in immunocompromised patients. CT scan is the gold standard for the definite diagnosis. Splenectomy is the treatment of choice, while medical therapy should be reserved for unusual pathogens provided that an effective antimicrobial agent is available.

Abdominal Abscess↗
PubMed2000

Cystic pancreatic neoplasms: computed tomography and magnetic resonance imaging findings.

Cystic pancreatic neoplasms include serous cystadenomas (SCA), mucin-producing cystic tumors, cystic islet-cell tumors, and cystic solid and papillary epithelial neoplasms. Imaging techniques are of great value in the demonstration and differential diagnosis of these tumors. In this article we present the computed tomography (CT) and magnetic resonance imaging (MRI) findings of the aforementioned cystic neoplasms. Although the radiological features are in many cases informative, a significant overlap does exist; fine-needle aspiration biopsy and cytology or excisional biopsy and histological examination are necessary to determine a definitive diagnosis.

Adenoma, Islet Cell↗
PubMed1999

Extended esophagolaryngeal resection with parathyroid autotransplantation.

Esopharyngolaryngeal resection for carcinoma of the cervical esophagus must be accompanied by resection of the thyroid gland, parathyroid bodies, and regional lymph nodes. In order to reduce long-term morbidity associated with the procedure, we performed parathyroid autotransplantation in two patients who underwent esophagolaryngeal resections. Grafting of the upper two parathyroid glands into the sternocleidomastoid muscle was carried out successfully in both cases. Graft function was rapidly restored. During the third postoperative week, blood levels of intact parathormone (PTH) reached 20 pg ml(-1) in the first case and 15 pg ml(-1) in the second, and the patients were successfully weaned off calcium and vitamin D supplementation. Parathyroid autotransplantation should be attempted in all cases of esophagolaryngeal resections provided that parathyroid glands are free of malignancy.

Aged↗
PubMed1998

Use of infrarenal conduits for arterial revascularization in orthotopic liver transplantation.

Arterial conduits that use donor iliac arteries represent a reliable technique for graft revascularization in orthotopic liver transplantation. We reviewed 757 consecutive liver transplantations performed between 1989 and 1995 for acute or chronic liver disease in adults and children. Of these, 218 patients received arterial conduits that used donor iliac arteries. The incidence of hepatic artery thrombosis (HAT) for conduits was 4.1% (9 of 218 patients) compared with 4% (22 of 539 patients) for direct arterial anastomosis. Patients in the arterial conduit group included 66% (99 of 159) of the children younger than 5 years of age, 75% (67 of 89) of all patients who underwent retransplantation, and, in particular, 25 patients regrafted for HAT. Arterial conduits provide an effective and reliable method of revascularization in patients at higher risk of arterial thrombosis. The actuarial 3-year patency rate for conduits is 95% and the incidence of HAT is similar to that in standard arterial anastomoses.

Adult↗
PubMed1998

Diaphragmatic nerve palsy in young children following liver transplantation. Successful treatment by plication of the diaphragm.

Diaphragmatic paralysis was identified in four children after liver transplantation. All presented with persistent right upper lobe atelectasis, pleural effusion and recurrent respiratory infections and could not be weaned from mechanical ventilatory support. Fluoroscopy and real-time ultrasound confirmed paradoxical right diaphragmatic movements. Diaphragmatic plication was undertaken and enabled rapid and sustained weaning from respiratory support in all four cases. Vascular clamping of the suprahepatic vena cava seems to be the cause. Diaphragmatic plication allows optimal recruitment of the respiratory muscles with a favourable impact on lung mechanics and gas exchange.

Child, Preschool↗
PubMed1998

Split liver transplantation: King's College Hospital experience.

BACKGROUND: The purpose of split liver transplantation is to increase the source of pediatric grafts without compromising the adult donor pool. Early results have been discouraging because of technical complications and selection of poor risk patients. METHODS: The results of a single center experience of 41 split liver transplantations were analyzed. Patient and graft survival and complications related to the technique were analyzed. RESULTS: Patient and graft survival for the whole group was 90% and 88% respectively at a median follow up of 12 months (range 6-70 months). Patient and graft survival for the right lobe graft was 95% and the left lateral segment 86% and 82% respectively. Four patients died, of which two of the patients were first two splits following technical complications. Two others died, one from cerebral lymphoma and the other of multiorgan failure secondary to sepsis. One patient has been retransplanted for chronic biliary sepsis. CONCLUSION: Split liver transplantation has now become an acceptable treatment option for both adult and pediatric recipients with end stage liver disease. Right lobe recipients are not disadvantaged by the procedure. Good results can be achieved with better patient selection and by the use of good quality organs.

Adolescent↗