Βιβλιογραφία

1. Esophagus. 2020 Apr;17(2):100-112. doi: 10.1007/s10388-020-00718-9. Epub 2020 Jan 23.

Enhanced recovery pathways vs standard care pathways in esophageal cancer surgery: systematic review and meta-analysis.

Triantafyllou T(1), Olson MT(2), Theodorou D(1), Schizas D(3), Singhal S(4).

Author information: (1)1st Propaedeutic Department of Surgery, Hippocration General Hospital of Athens, University of Athens, Athens, Greece. (2)University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA. (3)First Department of Surgery, Laikon General Hospital of Athens, Athens, Greece. (4)Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India. drsaurabhsinghal@gmail.com.

Enhanced recovery after surgery (ERAS) protocols vs standard care pathways after esophagectomy for malignancy have gained wide popularity among surgeons. However, the current literature is still lacking level-I evidence to show a clear superiority of one approach. The present study is a detailed systematic review and meta-analysis of the published trials. A systematic review of literature databases was conducted for randomized controlled trials (RCTs) and non-randomized, prospective, comparative studies between January 1990 and September 2019, comparing ERAS pathway group with standard care for esophageal resection for esophageal cancer. Mean difference (MD) for continuous variables and odds ratio (OR) or risk difference (RD) for dichotomous variables with 95% confidence interval (CI) were used. Between-study heterogeneity was evaluated. Eight studies with a total of 1133 patients were included. Hospital stay [Standard mean difference (Std. MD) = - 1.92, 95% CI – 2.78, – 1.06, P < 0.0001], overall morbidity (OR 0.68, CI 0.49, 0.96, P = 0.03), pulmonary complications (OR 0.45, CI 0.31, 0.65, P < 0.0001), anastomotic leak rate (OR 0.37, CI 0.18, 0.74, P = 0.005), time to first flatus and defecation (Std. MD = -5.01, CI – 9.53, – 0.49, P = 0.03), (Std. MD = - 1.36, CI – 1.78, – 0.94, P < 0.00001) and total hospital cost (Std. MD = - 1.62, CI – 2.24, – 1.01, P < 0.00001) favored the ERAS group. Patients who undergo ERAS have a clear benefit over the standard care protocol. However, existing protocols in different centers are followed by great variability, while the evaluated parameters suffer from significant heterogeneity. A well-formulated, standardized protocol should be standard-of-care at all centers.

DOI: 10.1007/s10388-020-00718-9 PMID: 31974853

2. Ann Gastroenterol. 2020 Sep-Oct;33(5):453-458. doi: 10.20524/aog.2020.0519. Epub 2020 Jun 22.

Esophageal cancer: challenges, concerns, and recommendations for management amidst the COVID-19 pandemic.

Triantafyllou T(1), Olson MT(2), Theodorou D(1), Zografos G(1), Singhal S(3).

Author information: (1)Department of Surgery, Hippocration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece (Tania Triantafyllou, Dimitrios Theodorou, Georgios Zografos). (2)Department of Surgery, University of Arizona College of Medicine – Phoenix Campus, Phoenix, AZ, USA (Michael T. Olson). (3)Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India (Saurabh Singhal).

Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, raising great concern, particularly in immunosuppressed cancer patients. The pandemic situation remains extremely dynamic, which necessitates proactive management decisions from oncologists and oncologic surgeons in effort to mitigate the risk of both SARS-CoV-2 infection and cancer metastasis. Esophageal cancer, in particular, is one of the deadliest types of malignancy worldwide, reflecting both aggressive biology and a lack of adequate treatment. Several challenges and concerns regarding the management of esophageal cancer have been raised in light of the ongoing viral pandemic. The primary aim of this review is to summarize the salient evidence for recommendations and optimal treatment strategies for patients with esophageal cancer amidst the COVID-19 pandemic.

DOI: 10.20524/aog.2020.0519 PMCID: PMC7406811 PMID: 32879590

Conflict of interest statement: Conflict of Interest: None

3. ANZ J Surg. 2020 Jan;90(1-2):182-184. doi: 10.1111/ans.15052. Epub 2019 Mar 5.

Case presentation of acanthosis nigricans diagnosed with gastric adenocarcinoma.

Chatzopoulou D(1), Triantafyllou T(1), Tsamis D(1), Chrysikos D(1), Kalles V(1), Zografos G(1), Theodorou D(1).

Author information: (1)Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, ‘Hippokration’ General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece.

DOI: 10.1111/ans.15052 PMID: 30836438 [Indexed for MEDLINE]

4. World J Gastrointest Surg. 2020 Mar 27;12(3):104-115. doi: 10.4240/wjgs.v12.i3.104.

Acute esophageal necrosis: A systematic review and pooled analysis.

Schizas D(1), Theochari NA(2), Mylonas KS(1), Kanavidis P(1), Spartalis E(3), Triantafyllou S(4), Economopoulos KP(5), Theodorou D(4), Liakakos T(1).

Author information: (1)First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece. (2)Department of Medicine, Surgery Working Group, Society of Junior Doctors, Athens 15122, Greece. nickyth12@gmail.com. (3)Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens 11527, Greece. (4)First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens 11527, Greece. (5)Department of Medicine, Surgery Working Group, Society of Junior Doctors, Athens 15122, Greece.

BACKGROUND: Acute esophageal necrosis (AEN) is a rare entity with multifactorial etiology, usually presenting with signs of upper gastrointestinal bleeding. AIM: To systematically review all available data on demographics, clinical features, outcomes and management of this medical condition. METHODS: A systematic literature search was performed with respect to the PRISMA statement (end-of-search date: October 24, 2018). Data on the study design, interventions, participants and outcomes were extracted by two independent reviewers. RESULTS: Seventy-nine studies were included in this review. Overall, 114 patients with AEN were identified, of whom 83 were males and 31 females. Mean patient age was 62.1 ± 16.1. The most common presenting symptoms were melena, hematemesis or other manifestations of gastric bleeding (85%). The lower esophagus was most commonly involved (92.9%). The most widely implemented treatment modality was conservative treatment (75.4%), while surgical or endoscopic intervention was required in 24.6% of the cases. Mean overall follow-up was 66.2 ± 101.8 d. Overall 29.9% of patients died either during the initial hospital stay or during the follow-up period. Gastrointestinal symptoms on presentation [Odds ratio 3.50 (1.09-11.30), P = 0.03] and need for surgical or endoscopic treatment [surgical: Odds ratio 1.25 (1.03-1.51), P = 0.02; endoscopic: Odds ratio 1.4 (1.17-1.66), P < 0.01] were associated with increased odds of complications. A sub-analysis separating early versus late cases (after 2006) revealed a significantly increased frequency of surgical or endoscopic intervention (9.7 % vs 30.1% respectively, P = 0.04). CONCLUSION: AEN is a rare condition with controversial pathogenesis and unclear optimal management. Although the frequency of surgical and endoscopic intervention has increased in recent years, outcomes have remained the same. Therefore, further research work is needed to better understand how to best treat this potentially lethal disease.

DOI: 10.4240/wjgs.v12.i3.104 PMCID: PMC7061242 PMID: 32218893

Conflict of interest statement: Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript. All the Authors have no conflict of interest related to the manuscript.

5. Dis Esophagus. 2019 Oct 30:doz083. doi: 10.1093/dote/doz083. Online ahead of print.

Esophageal melanoma: a systematic review and exploratory recurrence and survival analysis.

Schizas D(1), Mylonas KS(1), Bagias G(2), Mastoraki A(3), Ioannidi M(3), Kanavidis P(1), Hasemaki N(1), Karavokyros I(1), Theodorou D(4), Liakakos T(1).

Author information: (1)First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece. (2)Clinic for General, Visceral and Transplant Surgery, University Clinic Essen, Essen, Germany. (3)Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece. (4)First Propedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Esophageal melanoma is a rare and poorly described malignancy. We sought to review all available data on the clinicopathological features, management options, and outcomes of patients with esophageal melanoma to guide clinicians working to treat these uncommon tumors. A systematic literature search of the PubMed, Embase, and Cochrane databases was performed. Exploratory recurrence and survival analyses were performed using previously-validated pooled Cox and logistic regression techniques for case reports and case series. Quality assessment of included studies was performed using the tools developed by the Joanna Briggs and the National Heart, Lung, and Blood Institutes. Fifty-nine studies were reviewed. A total of 93 patients with esophageal melanoma were identified. The mean patient age was 61.2 ± 10.6 years. Esophageal melanoma usually developed at the lower esophagus (48.4%). 90.3% of the patients were symptomatic at presentation, with dysphagia being the most common symptom (72%). Esophagectomy was performed in 91.4% of the patients. Postoperatively, 14 patients (15.1%) received adjuvant chemotherapy. Tumor recurrence was seen in 37 patients (39.8%). The median time to recurrence was 6 months. Disease-specific mortality was 43%. All-cause mortality was 46.1%. On multivariable Cox regression, older patient age (hazard ratio [HR] = 0.91, P = 0.008) and higher Melan-A expression (HR = 0.21; P = 0.029) were associated with a significantly lower risk of mortality. Higher S100 levels (HR = 37.4; P = 0.001) were predictive of poor survival. On logistic regression, large, ulcerated, lower esophageal tumors were significantly more likely to recur (P = 0.018, P = 0.013, and P = 0.027 respectively). Esophageal melanoma is a rare malignancy that tends to present with dysphagia. Most surgically-treated patients undergo esophagectomy. Large, ulcerated, lower esophageal lesions recur more frequently. Immunohistochemistry provides prognostic information regarding survival.

© The Author(s) 2019. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

DOI: 10.1093/dote/doz083 PMID: 31665346

6. Ann Transl Med. 2019 Jul;7(14):310. doi: 10.21037/atm.2019.06.34.

The 100 most cited manuscripts in esophageal motility disorders: a bibliometric analysis.

Schizas D(1), Kapsampelis P(1), Tsilimigras DI(1), Kanavidis P(1), Moris D(2), Papanikolaou IS(3), Karamanolis GP(4), Theodorou D(5), Liakakos T(1).

Author information: (1)First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece. (2)Department of Surgery, Duke University Medical Center, Durham, NC, USA. (3)Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece. (4)Gastroenterology Unit, Second Department of Surgery, National and Kapodistrian University of Athens, Aretaieio University Hospital, Athens, Greece. (5)First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece.

BACKGROUND: The use of bibliometrics can help us identify the most impactful articles on a topic or scientific discipline and their influence on clinical practice. We aimed to identify the 100 most cited articles covering esophageal motility disorders and examine their key characteristics. METHODS: The Web of Science database was utilized to perform the search, using predefined search terms. The returned dataset was filtered to include full manuscripts written in the English language. After screening, we identified the 100 most cited articles and analyzed them for title, year of publication, names of authors, institution, country of the first author, number of citations and citation rate. RESULTS: The initial search returned 29,521 results. The top 100 articles received a total of 20,688 citations. The most cited paper was by Inoue et al. (665 citations) who first described peroral endoscopic myotomy (POEM) for treating achalasia. The article with the highest citation rate was the third version of the Chicago Classification system, written by Kahrilas and colleagues. Gastroenterology published most papers on the list (n=32) and accrued the highest number of citations (6,675 citations). Peter Kahrilas was the most cited author (3,650 citations) and, along with Joel Richter, authored the highest number of manuscripts (n=14). Most articles were produced in the USA (n=66) between the years 1991 and 2000 (n=32). CONCLUSIONS: By analyzing the most influential articles, this work is a reference on the articles that shaped our understanding of esophageal motility disorders, thus serving as a guide for future research.

DOI: 10.21037/atm.2019.06.34 PMCID: PMC6694239 PMID: 31475180

Conflict of interest statement: Conflicts of Interest: The authors have no conflicts of interest to declare.

7. Ann Gastroenterol. 2018 Jul-Aug;31(4):456-461. doi: 10.20524/aog.2018.0270. Epub 2018 May 3.

Can the upper esophageal sphincter contractile integral help classify achalasia?

Triantafyllou T(1), Theodoropoulos C(1), Mantides A(2), Chrysikos D(1), Smparounis S(1), Filis K(1), Zografos G(1), Theodorou D(1).

Author information: (1)Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Demosthenis Chrysikos, Spyridon Smparounis, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou). (2)Private Practice (Apostolos Mantides), Athens, Greece.

BACKGROUND: The use of high-resolution manometry (HRM) in achalasia patients has revealed abnormal findings concerning upper esophageal sphincter (UES) function. The introduction of the UES contractile integral (UES-CI), as with the distal contractile integral (DCI), may complement the interpretation of the manometric study of achalasia subtypes, defined by the Chicago Classification v3.0. METHODS: Patients were classified into achalasia subtypes based on HRM. UES length (cm), UES resting pressure (mmHg), and UES residual pressure (mmHg) were recorded. UES-CI (mmHg·sec·cm) was calculated in a manner similar to that used for the DCI measurement at rest (landmark CI), corrected for respiration, and its relation to achalasia subtypes was evaluated. RESULTS: Twenty-four achalasia patients with mean age 55.29 years were included. Of these, 16.6% (n=4) were diagnosed with achalasia type I, 58.3% (n=14) with type II, and 25% (n=6) with type III. The landmark UES-CI, mean UES-CI, UES-CI corrected for respiration, and UES resting pressure were found to be significantly higher among patients with achalasia type II compared to the other types (1768.9 vs. 677.1, P=0.03; 1827.1 vs. 3555.1, P=0.036; 174.2 vs. 72.8, P=0.027; and 108.1 vs. 55.8, P=0.009, respectively). CONCLUSIONS: We introduce the CI index as a tool for the manometric evaluation of the UES in achalasia. UES resting pressure, landmark UES-CI and mean UES-CI were significantly higher in achalasia patients with panesophageal pressurization compared to types I and III. This finding may reflect a protective reaction against the risk of aspiration in this group, but further studying and clinical correlation is required.

DOI: 10.20524/aog.2018.0270 PMCID: PMC6033759 PMID: 29991890

8. J BUON. 2017 Jul-Aug;22(4):1083-1084.

Synchronous double primary gastric tumors: sarcoma and adenocarcinoma.

Triantafyllou T(1), Markogiannakis H, Zografos G, Theodorou D.

Author information: (1)1st Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Medical School, National and Kapodistrian University of Athens, Greece.

PMID: 28952234 [Indexed for MEDLINE]

9. United European Gastroenterol J. 2019 Feb;7(1):45-51. doi: 10.1177/2050640618804717. Epub 2018 Oct 3.

First genotype-phenotype study reveals HLA-DQβ1 insertion heterogeneity in high-resolution manometry achalasia subtypes.

Vackova Z(1), Niebisch S(2), Triantafyllou T(3), Becker J(4)(5), Hess T(4)(5), Kreuser N(2), Kanoni S(6), Deloukas P(6), Schüller V(4)(5), Heinrichs SK(4)(5), Thieme R(2), Nöthen MM(4)(5), Knapp M(7), Spicak J(1), Gockel I(2), Schumacher J(4)(5), Theodorou D(3), Martinek J(1)(8)(9).

Author information: (1)Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. (2)Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany. (3)Foregut Surgery Department, Hippokration General Hospital of Athens, Athens, Greece. (4)Institute of Human Genetics, University of Bonn, Bonn, Germany. (5)Department of Genomics, University of Bonn, Bonn, Germany. (6)William Harvey Research Institute, University of London, London, UK. (7)Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany. (8)Institute of Physiology, Charles University in Prague, Prague, Czech Republic. (9)Faculty of Medicine, Ostrava University, Ostrava, Czech Republic.

BACKGROUND: Achalasia is a primary oesophageal motility disorder. Although aetiology remains mainly unknown, a genetic risk variant, rs28688207 in HLA-DQB1, showed strong achalasia association suggesting involvement of immune-mediated processes in the pathogenesis. High-resolution manometry recognises three types of achalasia. The aim of our study was to perform the first genotype-phenotype analysis investigating the frequency of rs28688207 across the high-resolution manometry subtypes. METHODS: This was a cross-sectional retrospective study. Achalasia patients from tertiary centres in the Czech Republic (n = 163), Germany (n = 114), Greece (n = 70) and controls were enrolled. All subjects were genotyped for the rs28688207 insertion. The Kruskal-Wallis test was used for the genotype-phenotype analysis. RESULTS: A total of 347 achalasia patients (type I – 89, II – 210, III – 48) were included. The overall frequency of the rs28688207 was 10.3%. The distribution of the insertion was significantly different across the high-resolution manometry subtypes (p = 0.038), being most prevalent in type I (14.6%), followed by type II (9.5%) and III (6.3%). CONCLUSION: The frequency of the HLA-DQB1 insertion differs among high-resolution manometry achalasia subtypes. The insertion is most prevalent in type I, suggesting that immune-mediated mechanisms triggered by the insertion may play a more prominent role in the pathogenesis of this subtype.

DOI: 10.1177/2050640618804717 PMCID: PMC6374847 PMID: 30788115 [Indexed for MEDLINE]

10. Ann Gastroenterol. 2019 Jan-Feb;32(1):46-51. doi: 10.20524/aog.2018.0326. Epub 2018 Nov 14.

Long-term outcome of myotomy and fundoplication based on intraoperative real-time high-resolution manometry in achalasia patients.

Triantafyllou T(1), Theodoropoulos C(1), Georgiou G(1), Kalles V(1), Chrysikos D(2), Filis K(1), Zografos G(1), Theodorou D(1).

Author information: (1)Department of Surgery, 1 Propaedeutic Surgical Clinic, Hippocration General Hospital of Athens, University of Athens (Tania Triantafyllou, Charalampos Theodoropoulos, Georgia Georgiou, Vasileios Kalles, Konstantinos Filis, Georgios Zografos, Dimitrios Theodorou). (2)General and Oncologic Hospital of Kifissia “Agii Anargiri” (Demosthenis Chrysikos), Athens, Greece.

BACKGROUND: Current treatment options for achalasia of the esophagus predominantly consist of endoscopic myotomy or laparoscopic myotomy combined with a partial fundoplication. The intraoperative use of conventional manometry has previously been proposed with various results. The aim of the present study was to introduce the use of high-resolution manometry (HRM) during surgical treatment for achalasia and to assess the long-term outcome of this technique. METHODS: We enrolled achalasia patients within the time period November 2013 to July 2016 who underwent HRM and evaluation of Eckardt scores (ES) before and after tailored laparoscopic myotomy and fundoplication with intraoperative recording using HRM. RESULTS: Twenty patients were classified as having achalasia type I (20%), type II (55%), or type III (25%). During surgery, 9 myotomies were extended and 13 fundoplications were modified according to HRM findings. Mean resting (16.1 vs. 41.9 mmHg) and residual (9 vs. 28.7 mmHg) pressures of the lower esophageal sphincter and ES (0.7 vs. 6.9) were significantly eliminated postoperatively over a mean follow-up time of 17.7 months. CONCLUSIONS: The use of intraoperative HRM gives us the advantage of simultaneous real-time estimation of intraluminal pressures of the esophagus and the ability to identify the exact points that produce pressure during laparoscopy. Consequently, it may be the key to the tailoring of the Heller-Dor technique and improving the outcomes for achalasia patients.

DOI: 10.20524/aog.2018.0326 PMCID: PMC6302195 PMID: 30598591

Conflict of interest statement: Conflict of Interest: None.

11. World J Gastroenterol. 2006 Mar 7;12(9):1481-4. doi: 10.3748/wjg.v12.i9.1481.

Rectal carcinosarcoma: a case report and review of literature.

Tsekouras DK(1), Katsaragakis S, Theodorou D, Kafiri G, Archontovasilis F, Giannopoulos P, Drimousis P, Bramis J.

Author information: (1)1st University Department of General Surgery, Athens School of Medicine, Ippokration Hospital, Athens, Greece. ditsek74@hotmail.com

A 60-years old male was admitted to our department for investigation of constipation and hypogastric discomfort intensified during defecation of a few weeks duration. The cause proved to be a rectal carcinosarcoma that was treated by abdominoperineal resection and postoperative chemo-radiotherapy. The patient died 6 months later due to hepatic failure, showing evidence of disseminated disease. In general colonic carcinosarcomas constitute a rare category of malignant neoplasms whose nature is still incompletely understood. No specific treatment guidelines exist. Surgery is the mainstay of treatment and regardless of the addition of adjuvant therapy the prognosis is very poor. Systematic genetic analysis may be the clue for understanding the pathogenesis of these mysterious tumors.

DOI: 10.3748/wjg.v12.i9.1481 PMCID: PMC4124336 PMID: 16552827 [Indexed for MEDLINE]

12. Cases J. 2008 Jul 14;1(1):34. doi: 10.1186/1757-1626-1-34.

Abdominal shotgun trauma: A case report.

Toutouzas KG(1), Larentzakis A, Drimousis P, Riga M, Theodorou D, Katsaragakis S.

Author information: (1)Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Hippokrateion General Hospital, Athens Medical School, University of Athens, Q, Sofias 114 av,,11527, Athens, Greece. alarentz@med.uoa.gr.

INTRODUCTION: One of the most lethal mechanisms of injury is shotgun wound and particularly the abdominal one. CASE PRESENTATION: We report a case of a 45 years old male suffering abdominal shotgun trauma, who survived his injuries. CONCLUSION: The management of the abdominal shotgun wounds is mainly dependent on clinical examination and clinical judgment, while requires advanced surgical skills.

DOI: 10.1186/1757-1626-1-34 PMCID: PMC2491597 PMID: 18625076

13. Int J Surg Case Rep. 2012;3(2):74-7. doi: 10.1016/j.ijscr.2011.08.017. Epub 2011 Nov 11.

Bougie insertion: A common practice with underestimated dangers.

Theodorou D(1), Doulami G, Larentzakis A, Almpanopoulos K, Stamou K, Zografos G, Menenakos E.

Author information: (1)First Department of Propaedeutic Surgery, University of Athens, Athens Medical School, Hippocration Hospital of Athens, Greece.

INTRODUCTION: Esophageal perforation after bariatric operations is rare. We report two cases of esophageal perforation after bariatric operations indicating the dangers of a common practice – like insertion of esophageal tubes – and we describe our management of that complication. PRESENTATION OF CASE: A 56 year old woman who underwent laparoscopic sleeve gastrectomy and a 41 year old woman who underwent laparoscopic adjustable gastric banding respectively. In both operations a bougie has been used and led to esophageal perforation. DISCUSSION: The insertion of bougie and especially of inflated bougie is a common practice. It is an invasive procedure that in most cases is performed by the anesthesiologist team. CONCLUSION: Bougie insertion is an invasive procedure with risks and should always be attempted under direct supervision of surgical team or should be inserted by a surgeon.

DOI: 10.1016/j.ijscr.2011.08.017 PMCID: PMC3267246 PMID: 22288051

14. APMIS. 2015 Aug;123(8):639-47. doi: 10.1111/apm.12398. Epub 2015 Apr 27.

Immunohistochemical and molecular analysis of PI3K/AKT/mTOR pathway in esophageal carcinoma.

Tasioudi KE(1), Sakellariou S(1), Levidou G(1), Theodorou D(2), Michalopoulos NV(2), Patsouris E(1), Korkolopoulou P(1), Saetta AA(1).

Author information: (1)1st Department of Pathology, Medical School, National and Kapodistrian University of Athens, Goudi, Athens, Greece. (2)1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece.

Among the numerous signaling pathways involved in tumorigenesis, PI3K-AKT-mTOR is a key one that regulates diverse cellular functions. However, its prognostic value in esophageal carcinoma remains unclear. In our study, we examined the immunohistochemical expression of phosphorylated (p-) AKT, mTOR, p70S6K and 4E-BP1 along with the mutational status of PIK3CA and AKT1 genes by High Resolution Melting Analysis and Pyrosequencing in 44 esophageal carcinomas. The results were correlated with the clinicopathological characteristics of the patients in an effort to define their possible prognostic significance. Total p-mTOR cytoplasmic expression, assessed in 10 random areas, was positively correlated with tumor stage (Kruskal-Wallis ANOVA, I/II vs III/IV, p = 0.0500). Μoreover, maximum p-mTOR cytoplasmic immunoexpression, estimated in hot spot areas, was positively associated with tumor grade (Mann-Whitney U test, I/II vs III, p = 0.0565). Interestingly, p-4E-BP1 immunoreactivity was negatively correlated with tumor histological grade (Mann-Whitney U test, I/II vs III, p = 0.0427). No mutation was observed in exons 9 and 20 of PIK3CA gene and in exon 4 of AKT1 gene. In conclusion, our findings depict the presence of activated PI3K/AKT/mTOR pathway in esophageal cancer bringing forward p-mTOR and p-4E-BP1 for their potential role in esophageal carcinogenesis. Additional studies are warranted to validate our findings.

DOI: 10.1111/apm.12398 PMID: 25912437 [Indexed for MEDLINE]

15. Pathol Res Pract. 2012 Jul 15;208(7):398-404. doi: 10.1016/j.prp.2012.05.009. Epub 2012 Jun 2.

pERK activation in esophageal carcinomas: clinicopathological associations.

Tasioudi KE(1), Saetta AA, Sakellariou S, Levidou G, Michalopoulos NV, Theodorou D, Patsouris E, Korkolopoulou P.

Author information: (1)1st Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Assias, Goudi 11527, Greece. ntasioudi@gmail.com

MAPK (mitogen-activated protein kinase) pathway is considered a control regulator in various malignant tumors but its role in esophageal carcinomas remains elusive. In our study, we examined the possible prognostic significance of MAPK pathway in human esophageal cancer. We searched for mutations in exons 18-21 of EGFR gene, codons 12 and 13 of K-RAS gene and exon 15 of B-RAF gene by high resolution melting analysis (HRMA) and pyrosequencing in 44 esophageal carcinomas. Immunohistochemistry was performed in 29 cases in order to evaluate expression levels of pERK (extracellular-signal regulated kinase). In one laser microdissected squamous cell carcinoma, a somatic K-RAS mutation at codon 12 was detected, whereas none of the cases displayed mutations in EGFR and B-RAF genes. Elevated nuclear as well as cytoplasmic pERK expression (100% and 62% of cases respectively) was observed independently of EGFR and B-RAF mutational status. Increasing pERK nuclear and cytoplasmic expression as well as the intensity of nuclear staining was found to be significantly correlated with tumor grade in univariate and multivariate statistical analysis. Our findings depict the presence of activated ERK despite the low frequency of upstream alterations, implicating ERK activation in the acquisition of a more aggressive phenotype in esophageal cancer.

DOI: 10.1016/j.prp.2012.05.009 PMID: 22658382 [Indexed for MEDLINE]

16. Semin Laparosc Surg. 2001 Dec;8(4):272-80.

Causes of failure of antireflux surgery.

Theodorou DA(1), Peters JH.

Author information: (1)Department of Surgery, University of Southern California, Los Angeles, CA 90033, USA.

The multiple advantages of the laparoscopic techniques were the main reason for the explosion of laparoscopic antireflux surgery. As a result, laparoscopic Nissen fundoplication has become one of the most commonly performed laparoscopic procedures. Achieving consistently successful results is difficult with any form of therapy, and laparoscopic fundoplication is no exception. The definition of failure of antireflux surgery is unclear and is usually based on the patient’s symptoms. In this report, we analyze the different types of failure and discuss the diagnostic and therapeutic options that are available to manage this challenging clinical problem.

PMID: 11813145 [Indexed for MEDLINE]

17. J Surg Res. 2013 Jan;179(1):e177-82. doi: 10.1016/j.jss.2012.01.040. Epub 2012 Mar 14.

Porcine model of hemorrhagic shock with microdialysis monitoring.

Larentzakis A(1), Toutouzas KG, Papalois A, Lapidakis G, Doulgerakis S, Doulami G, Drimousis P, Theodorou D, Katsaragakis S.

Author information: (1)First Propaedeutic Surgical Clinic, Hippocratio Hospital, Athens Medical School, University of Athens, Athens, Greece. alarentz@med.uoa.gr

BACKGROUND: A number of experimental protocols have been used to try to reproduce the clinical scenarios of hemorrhagic shock. The present study reports on an experimental swine model of controlled hemorrhagic shock that incorporates microdialysis monitoring for the evaluation of tissue perfusion and oxygenation. The aim of our study was to provide a reproducible, accurate, and reliable model for the testing and evaluation of therapeutic interventions in the area of hemorrhagic shock. METHODS: Landrace swine (n = 8) were subjected to controlled hemorrhagic shock, with a mean arterial pressure of 35 ± 5 as the endpoint. Six more pigs were used as the control group. Microdialysis monitoring of the tissue lactate/pyruvate ratio was used. The mean arterial pressure, heart rate, hematocrit, hemoglobin, and lactate/pyruvate ratio measurements were obtained just before (phase A) and 30 min after (phase B) hemorrhage in the study group; the control group underwent the same measurements at the corresponding points. RESULTS: The mean arterial pressure, hematocrit, and hemoglobin were lower (P < 0.05) in the study group than in the control group at phase B and compared with the values for the study group at phase A. Also, the lactate/pyruvate ratio and heart rate were greater (P < 0.05) in the study group than in control group at phase B and compared with the values for the study group at phase A. CONCLUSIONS: This model of hemorrhagic shock is effective and correlates with the clinical parameters of tissue oxygenation, as documented by microdialysis.

DOI: 10.1016/j.jss.2012.01.040 PMID: 22480841 [Indexed for MEDLINE]

18. Arch Sex Behav. 2012 Jun;41(3):537. doi: 10.1007/s10508-012-9938-2.

Sexual behavior in an intensive care unit.

Tsamis D, Theodorou D, Katsaragakis S.

DOI: 10.1007/s10508-012-9938-2 PMID: 22399054 [Indexed for MEDLINE]

19. J Clin Gastroenterol. 2009 May-Jun;43(5):500. doi: 10.1097/MCG.0b013e318182c2fa.

Protection of intestinal permeability in the perioperative period.

Theodorou D, Aggeli P, Markogiannakis H, Skouroliakou M, Archontovasilis F, Kastanidou O, Burnetas A, Xiromeritou V, Katsaragakis S.

DOI: 10.1097/MCG.0b013e318182c2fa PMID: 19564815 [Indexed for MEDLINE]

20. Int J Surg Case Rep. 2016;25:215-7. doi: 10.1016/j.ijscr.2016.06.051. Epub 2016 Jul 1.

Esophageal remnant cancer 35 years after acidic caustic injury: A case report.

Ntanasis-Stathopoulos I(1), Triantafyllou S(2), Xiromeritou V(3), Bliouras N(2), Loizou C(2), Theodorou D(2).

Author information: (1)Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas. Sofias Av., 11527 Athens, Greece. Electronic address: j.dan@windowslive.com. (2)Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas. Sofias Av., 11527 Athens, Greece. (3)Department of Gastroenterology, “Hippokration” General Hospital of Athens, Athens, Greece.

Erratum in Int J Surg Case Rep. 2016;29:16.

INTRODUCTION: Esophageal squamous cell carcinoma has been described as a long-term consequence following ingestion of corrosive substances. PRESENTATION OF CASE: We report a rare case of a 62-year-old female patient with a history of acidic caustic injury 35 years ago, for which she had undergone near total esophagogastrectomy with right colon interposition. Recently, she presented with worsening dysphagia, weight loss, neck swelling and chest pain. After the diagnostic workup, an invasive squamous cell carcinoma of the esophagus was confirmed. To our knowledge, this is the first such report in the literature. DISCUSSION: The risk for esophageal carcinoma increases substantially after ingestion of caustic substances. It is notable that distinct patterns of carcinogenesis between acids and alkalis may be postulated, since the corresponding pathophysiological impact of each one differ significantly. Although such esophageal cancers tend to have good prognosis due to early detection, both the diagnostic and therapeutic strategy may be challenging due to the limited available data in this field. Surgical treatment does not seem to eliminate the risk of cancer, as evident upon the present case report. CONCLUSION: Optimal management of esophageal corrosive injuries remains a debatable issue in terms of choosing between conservative therapy and surgical intervention. For this reason, the need for long-term follow up regardless the ingested substance and the preferred therapeutic approach is highlighted.

DOI: 10.1016/j.ijscr.2016.06.051 PMCID: PMC4941112 PMID: 27394396

21. Ann Surg. 2014 Apr;259(4):e67. doi: 10.1097/SLA.0000000000000364.

A multicenter study of survival after neoadjuvant radiotherapy/chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer.

Larentzakis A, Theodorou D.

Erratum in Ann Surg. 2014 Jul;260(1):21. Andreas, Larentzakis [corrected to Larentzakis, Andreas]; Dimitrios, Theodorou [corrected to Theodorou, Dimitrios].

Comment in Ann Surg. 2014 Apr;259(4):e68.

Comment on Ann Surg. 2014 Apr;259(4):744-9.

DOI: 10.1097/SLA.0000000000000364 PMID: 24263308 [Indexed for MEDLINE]

22. J Stroke Cerebrovasc Dis. 2015 Mar;24(3):711-7. doi: 10.1016/j.jstrokecerebrovasdis.2014.11.024. Epub 2015 Jan 16.

Cardiac troponin I after carotid endarterectomy in different cardiac risk patients.

Galyfos G(1), Tsioufis C(2), Theodorou D(3), Katsaragakis S(3), Zografos G(3), Filis K(3).

Author information: (1)First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece. Electronic address: georgegalyfos@hotmail.com. (2)First Department of Cardiology, University of Athens Medical School, Hippocration Hospital, Athens, Greece. (3)First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.

BACKGROUND: We compared postoperative cardiac damage, defined as cardiac troponin I (cTnI) elevation, in low, medium, and high cardiac risk patients, after carotid endarterectomy (CEA). METHODS: The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) criteria for stratifying patients considered for vascular surgery into low, medium, and high cardiac risk groups were used prospectively. For all patients (n = 324), cTnI value assessments were made before surgery and on postoperative days 1, 3, and 7. Postoperative cTnI values ranging from .05 to .5 ng/mL were classified as myocardial ischemia; values more than .5 ng/mL were classified as myocardial infarction. Cardiac damage was defined as either myocardial ischemia or infarction. RESULTS: Mortality was .003%, stroke rate was null, and symptomatic myocardial infarction was null as well. Low-risk patients (16 of 140) and medium-risk patients (28 of 160) increased their troponin levels on days 1 and 3 postoperatively. However, none of the high-risk patients (n = 24) showed any postoperative cardiac damage. Low and medium cardiac risk patients showed higher troponin values on each separate day, in comparison with high cardiac risk patients. CONCLUSIONS: CEA is followed by a high incidence of asymptomatic cTnI increase that is associated with late cardiac events. However, high cardiac risk patients as defined by the VSG-CRI criteria do not seem to suffer higher cardiac damage after CEA compared with low and medium cardiac risk patients.

DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.024 PMID: 25601178 [Indexed for MEDLINE]

23. Ann Thorac Surg. 2007 Aug;84(2):651-2. doi: 10.1016/j.athoracsur.2007.03.020.

Fecopneumothorax: a rare complication of esophagectomy.

Markogiannakis H(1), Theodorou D, Tzertzemelis D, Dardamanis D, Toutouzas KG, Misthos P, Katsaragakis S.

Author information: (1)First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece. markogiannakis@easy.com

Intrathoracic colon herniation after esophagectomy is rare. Furthermore, fecopneumothorax is an extremely infrequent clinical entity. We believe this is the first report in the literature of a patient with fecopneumothorax due to diverticular perforation of intrathoracically herniated transverse colon 2 months after transthoracic esophagectomy and cervical esophagogastric anastomosis. The relative literature addressing cause, clinical presentation, diagnosis, management, and prevention of this life-threatening complication of esophagectomy is reviewed.

DOI: 10.1016/j.athoracsur.2007.03.020 PMID: 17643655 [Indexed for MEDLINE]

24. Int Surg. 2015 Jan;100(1):173-9. doi: 10.9738/INTSURG-D-13-00186.1.

The use of serum uric acid concentration as an indicator of laparoscopic sleeve gastrectomy success.

Menenakos E(1), Doulami G, Tzanetakou IP, Natoudi M, Kokoroskos N, Almpanopoulos K, Leandros E, Zografos G, Theodorou D.

Author information: (1)1st Propaedeutic Surgical Department, “Hippokration” General Hospital of Athens, Medical School of Athens, National and Kapodistrian University of Athens, Greece.

Laparoscopic sleeve gastrectomy (LSG) effectively reduces weight by restricting gastric capacity and altering gut hormones levels. We designed a prospective study to investigate the correlation of serum uric acid (SUA) concentration and weight loss. SUA and body mass index (BMI) were measured preoperatively and on first postoperative month and year in patients who underwent LSG in our department of bariatric surgery. Data on 55 patients were analyzed. Preoperative SUA concentration had a significant positive correlation with percentage of total weight loss (TWL) on first postoperative month (P = 0.001) and year (P = 0.002). SUA concentration on first postoperative month had a positive correlation with percentage of TWL on first postoperative year (P = 0.004). SUA concentration could be used as a predictor of LSG’s success and could help in early detection of patients with rapid loss of weight, in order to prevent complications.

DOI: 10.9738/INTSURG-D-13-00186.1 PMCID: PMC4301285 PMID: 25594659 [Indexed for MEDLINE]

25. Surg Obes Relat Dis. 2018 Apr;14(4):484-488. doi: 10.1016/j.soard.2017.10.012. Epub 2017 Oct 26.

Acid and nonacid gastroesophageal reflux after single anastomosis gastric bypass. An objective assessment using 24-hour multichannel intraluminal impedance-pH metry.

Doulami G(1), Triantafyllou S(2), Albanopoulos K(3), Natoudi M(3), Zografos G(4), Theodorou D(2).

Author information: (1)Foregut Department, 1(st) Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: tzinagb@yahoo.gr. (2)Foregut Department, 1(st) Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece. (3)Bariatric Surgery Department, 1(st) Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece. (4)1(st) Propaedeutic Surgical Department, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece.

Comment in Surg Obes Relat Dis. 2018 Apr;14(4):488-489. Surg Obes Relat Dis. 2018 Sep;14(9):1419-1420.

BACKGROUND: Single anastomosis gastric bypass (SaGB) was introduced in 2001 as an alternative to “loop” gastric bypass. It was considered as a procedure that would eliminate alkaline reflux and associated esophagitis. OBJECTIVES: Existing evidence about the postoperative incidence of gastroesophageal reflux (GERD) after SaGB is based on studies using symptom questionnaires. The aim of our study was to evaluate GERD 12 months after SaGB by using 24-hour multichannel intraluminal impedance pH metry (24-h MIIpH). SETTING: Surgical department of a university hospital METHODS: Morbidly obese candidates for SaGB underwent 24-hour MIIpH prior and 12 months after their bariatric procedure. RESULTS: There were 11 patients included in this prospective study. Results of 24-hour MIIpH revealed that DeMeester score (40.48 versus 24.16, P = .339) had an increasing trend 12 months after SaGB. Acid reflux episodes decreased, whereas nonacid reflux episodes increased postoperatively, both in proximal and distal esophagus. Total median bolus clearance time and acid clearance time increased. De novo GERD developed in 2 patients (28.6%) and worsening of already existing GERD developed in all patients with preoperative evidence of GERD. CONCLUSION: The use of symptom questionnaires to assess postoperative GERD after SaGB may not accurately depict the real image. Twenty-four-hour MIIpH in 12 months after SaGB revealed an increase of total number of nonacid reflux episodes and a decrease of total number of acid reflux episodes, with longer duration of each acid reflux episode. Close postoperative follow-up with reflux testing and possibly endoscopy could eliminate the risk of complicated GERD.

DOI: 10.1016/j.soard.2017.10.012 PMID: 29203406 [Indexed for MEDLINE]

26. J BUON. 2017 Jan-Feb;22(1):280-281.

Challenging management of synchronous cancers presenting with dysphagia.

Ntanasis-Stathopoulos I(1), Triantafyllou T, Sfougatakis N, Theodorou D.

Author information: (1)Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece.

PMID: 28365968 [Indexed for MEDLINE]

27. J Gastrointest Surg. 2012 Mar;16(3):469-74. doi: 10.1007/s11605-011-1776-3. Epub 2011 Nov 18.

Intraluminal pH and goblet cell density in Barrett’s esophagus.

Theodorou D(1), Ayazi S, DeMeester SR, Zehetner J, Peyre CG, Grant KS, Augustin F, Oh DS, Lipham JC, Chandrasoma PT, Hagen JA, DeMeester TR.

Author information: (1)Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

INTRODUCTION: Goblet cells in Barrett’s esophagus (BE) vary in their density within the Barrett’s segment. Exposure of Barrett’s epithelium to bile acids is a major stimulant for goblet cell formation. The dissociation of bile acids into forms that penetrate Barrett’s epithelium is known to be pH dependent. We hypothesized that variations in the esophageal luminal pH environment explains the variability in goblet cell density. The aim of this study was to correlate esophageal luminal pH with goblet cell density in patients with BE. METHODS: A customized six-sensor pH catheter was positioned with the most distal sensor in the stomach and the remaining sensors located 1 cm below and 1, 3, 5, and 8 cm above the upper border of the lower esophageal sphincter in five normal subjects and six patients with long-segment BE. The luminal pH was measured by each sensor for 24-h and expressed as median pH. Patients with BE had four quadrant biopsies at levels corresponding to the location of the pH sensors. Goblet cell density was graded from 0 to 3 based on the number per high-power field. RESULTS: In normal subjects, the median pH values recorded in the sensors within the lower esophageal sphincter (LES) and esophageal body were all above 5. In patients with BE, the median pH recorded by the sensor within the LES was 2.8 and increased progressively to 4.7 in the sensor at 8 cm above the LES. Goblet cell density was significantly lower in the distal Barrett’s segment exposed to a median pH of 2.2 and increased in the proximal Barrett’s segment exposed to a median pH of 4.4 (p = 0.003). CONCLUSION: Patients with BE have a goblet cell gradient that correlates directly with an esophageal luminal pH gradient. This suggests that goblet cell differentiation is pH dependent and likely due to the effect of pH on bile acid dissociation.

DOI: 10.1007/s11605-011-1776-3 PMID: 22095525 [Indexed for MEDLINE]

28. Cases J. 2008 Sep 24;1(1):182. doi: 10.1186/1757-1626-1-182.

Sister Mary Joseph’s nodule: Three case reports.

Larentzakis A(1), Theodorou D, Fili K, Manataki A, Bizimi V, Tibishrani M, Katsaragakis S.

Author information: (1)1st Department of Propaedeutic Surgery, Hippokrateion General Hospital, Athens Medical School, University of Athens, Q, Sofias 114 av,, 11527, Athens, Greece. alarentz@med.uoa.gr.

BACKGROUND: An umbilical metastatic lesion is called ‘Sister Mary Joseph’s nodule’. It is an uncommon clinical or radiographic finding, and it is rare as the first sign of a malignant disease. CASE PRESENTATION: We report three cases of Sister Mary Joseph’s nodule. In the three cases presented, the primary tumor was an adenocarcinona of the sigmoid colon, a carcinoma of the bladder, and an adenocarcinoma of the gallbladder, respectively. CONCLUSION: The differential diagnosis of an umbilical lesion should always include metastatic disease apart from benign lesions and primary neoplasms.

DOI: 10.1186/1757-1626-1-182 PMCID: PMC2561010 PMID: 18816407

29. Echocardiography. 2015 Jul;32(7):1087-93. doi: 10.1111/echo.12826. Epub 2014 Nov 1.

Predictive role of stress echocardiography before carotid endarterectomy in patients with coronary artery disease.

Galyfos G(1), Tsioufis C(2), Theodorou D(1), Katsaragakis S(1), Zografos G(1), Filis K(1).

Author information: (1)First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece. (2)First Department of Cardiology, University of Athens Medical School, Hippocration Hospital, Athens, Greece.

OBJECTIVES: Our aim was to examine the predictive value of preoperative stress echocardiography regarding early myocardial ischemia and late cardiac events after carotid endarterectomy (CEA). METHODS: Patients with coronary artery disease undergoing CEA were prospectively included in this study. All patients (n = 162) were classified into low, medium, and high cardiac risk group, according to preoperative stress echocardiography. Classification was based on the criteria of the American Society of Echocardiography. For all patients, cTnI was measured before surgery and on postoperative days 1, 3, and 7. Postoperative cTnI values ranging from 0.05 to 0.5 ng/mL were classified as myocardial ischemia; values >0.5 ng/mL were classified as myocardial infarction. Cardiac damage was defined as either myocardial ischemia or infarction. RESULTS: No deaths, strokes, or symptomatic coronary events were observed during the early postoperative period. There were 112 low cardiac risk patients, 42 medium-risk patients, and 8 high-risk patients, according to stress echocardiography findings. Overall, there were 22 patients (14%) that increased their cTnI values postoperatively (12 of low cardiac risk and 10 of medium cardiac risk), and all of them were asymptomatic. None of the high-risk patients showed any troponin increase. Late cardiac events were associated with cTnI increase, although no high-risk patients showed any late event. CONCLUSIONS: Preoperative stress echocardiography does not seem to independently recognize patients in high risk for asymptomatic cardiac damage after CEA. Postoperative troponin elevation seems to be more predictive for late adverse cardiac events than preoperative stress echocardiography.

DOI: 10.1111/echo.12826 PMID: 25363093 [Indexed for MEDLINE]

30. Surg Endosc. 2013 Dec;27(12):4625-30. doi: 10.1007/s00464-013-3083-4. Epub 2013 Jul 9.

The effect of laparoscopic sleeve gastrectomy on the antireflux mechanism: can it be minimized?

Kleidi E(1), Theodorou D, Albanopoulos K, Menenakos E, Karvelis MA, Papailiou J, Stamou K, Zografos G, Katsaragakis S, Leandros E.

Author information: (1)First Propaedeutic Department of Surgery, Hippocration Hospital, University of Athens, 13-15 Zichnis St., 11 527, Athens, Greece, ele.kleidi@gmail.com.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a promising procedure for the treatment of morbid obesity. The stomach is usually transected near the angle of His; hence, the lower esophageal sphincter (LES) may be affected with consequences on postoperative gastroesophageal reflux disease (GERD). The purpose of this study was to examine the effect of LSG on the LES and postoperative GERD. METHODS: Severely obese asymptomatic patients submitted to LSG underwent esophageal manometry and GERD evaluation preoperatively and at least 6 weeks postoperatively. Data reviewed included patient demographics, manometric measurements, GERD symptoms, and pathology. Statistical analysis was performed by SPSS software. RESULTS: Twelve male and eleven female patients participated in the study. Mean age was 38.5 ± 10.9 years, and initial body mass index was 47.9 ± 5.1 kg/m(2). At follow-up examination, mean excess body mass index loss was 32.3 ± 12.7%. The LES total and abdominal length increased significantly postoperatively, whereas the contraction amplitude in the lower esophagus decreased. There was an increase in reflux symptoms postoperatively (p < 0.009). The operating surgeon who mostly approximated the angle of His resulted in an increased abdominal LES length (p < 0.01). The presence of esophageal tissue in the specimen correlated with increased total GERD score (p < 0.05). CONCLUSIONS: LSG weakens the contraction amplitude of the lower esophagus, which may contribute to postoperative reflux deterioration. It also increases the total and the abdominal length of the LES, especially when the angle of His is mostly approximated. However, if this approximation leads to esophageal tissue excision, reflux is again aggravated. Thus, stapling too close to the angle of His should be done cautiously.

DOI: 10.1007/s00464-013-3083-4 PMID: 23836127 [Indexed for MEDLINE]

31. World J Gastroenterol. 2013 Jul 21;19(27):4351-5. doi: 10.3748/wjg.v19.i27.4351.

A new pancreaticojejunostomy technique: a battle against postoperative pancreatic fistula.

Katsaragakis S(1), Larentzakis A, Panousopoulos SG, Toutouzas KG, Theodorou D, Stergiopoulos S, Androulakis G.

Author information: (1)1(st) Department of Propaedeutic Surgery, Athens Medical School, Hippocratio Athens General Hospital, University of Athens, 11527 Attiki, Greece.

AIM: To present a new technique of end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation, and insertion of a silicone stent. METHODS: We present an end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation, and the insertion of a silicone stent. This technique was performed in thirty-two consecutive patients who underwent a pancreaticoduodenectomy procedure by the same surgical team, from January 2005 to March 2011. The surgical procedure performed in all cases was classic pancreaticoduodenectomy, without preservation of the pylorus. The diagnosis of pancreatic leakage was defined as a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase concentration greater than three times the serum amylase activity. RESULTS: There were 32 patients who underwent end-to-side, duct-to-mucosa pancreaticojejunostomy with seromuscular jejunal flap formation. Thirteen of them were women and 19 were men. These data correspond to 40.6% and 59.4%, respectively. The mean age was 64.2 years, ranging from 55 to 82 years. The mean operative time was 310.2 ± 40.0 min, and was defined as the time period from the intubation up to the extubation of the patient. Also, the mean time needed to perform the pancreaticojejunostomy was 22.7 min, ranging from 18 to 25 min. Postoperatively, one patient developed a low output pancreatic fistula, three patients developed surgical site infection, and one patient developed pneumonia. The rate of overall morbidity was 15.6%. There was no 30-d postoperative mortality. CONCLUSION: This modification appears to be a significantly safe approach to the pancreaticojejunostomy without adversely affecting operative time.

DOI: 10.3748/wjg.v19.i27.4351 PMCID: PMC3718903 PMID: 23885146 [Indexed for MEDLINE]

32. Am Surg. 2000 Sep;66(9):809-12.

Fetal death after trauma in pregnancy.

Theodorou DA(1), Velmahos GC, Souter I, Chan LS, Vassiliu P, Tatevossian R, Murray JA, Demetriades D.

Author information: (1)Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.

Trauma in pregnancy places the mother and fetus at risk. The objective of this study is to identify risk factors independently associated with acute termination of pregnancy and/or fetal mortality after trauma. The medical and trauma registry records of 80 injured pregnant patients were reviewed. Data were collected and then analyzed by univariate and multivariate analysis. Three patients died (3.7%), 23 had the pregnancy acutely terminated (30%), and 14 suffered fetal death (17.5%). The only independent risk factors for fetal mortality were an Injury Severity Score (ISS) > or =9 and a nonviable pregnancy (<23 weeks). The combination of both risk factors increased the likelihood of fetal mortality by fivefold over that of patients without either risk factor. Maternal hemodynamic parameters did not predict fetal loss. Two patients lost their fetuses despite insignificant trauma (ISS = 1) and normal hemodynamic parameters, whereas eight delivered normal babies despite major trauma (ISS > or = 16). Hemodynamic stability on admission does not predict fetal mortality. Although the presence of moderate to severe injuries (ISS > or = 9) increases the likelihood of fetal mortality, this complication may occur even with insignificant trauma. Close maternal and fetal monitoring is justified, regardless of maternal hemodynamic presentation or severity of injury.

PMID: 10993605 [Indexed for MEDLINE]

33. Brain Inj. 2010;24(6):871-6. doi: 10.3109/02699051003789237.

Traumatic brain injury in Greece: report of a countrywide registry.

Katsaragakis S(1), Drimousis PG, Toutouzas K, Stefanatou M, Larentzakis A, Theodoraki ME, Stergiopoulos S, Theodorou D.

Author information: (1)Surgical Intensive Care Unit, 1st Department of Propeudeutic Surgery, University of Athens Medical School, Athens, Greece.

INTRODUCTION: The purpose of this study was to evaluate the incidence of TBI in Greece and to provide evidence on the epidemiologic characteristics of the disease. PATIENTS AND METHODS: This is a prospective observational study initiated by the Hellenic Society of Trauma and Emergency Surgery. Thirty hospitals participated in the registry. All trauma patients requiring admission transfer to a higher level centre and those who arrived dead were included in the study. This report evaluated the epidemiologic characteristics of patients with brain trauma, the cause and the severity of the injury and the final outcome. RESULTS: Eight thousand eight hundred and sixty-two patients were included in the registry. Of them, 3383 had at least one brain injury. There were 2451 males and 932 females. Traffic accidents were the leading cause of TBI (54.1%), followed by falls (27.7%). The most affected age group was the 15-44 year olds (48.0%), but TBIs were more lethal in the 45-64 age group (17.8%). Interestingly, a 3.4% mortality was recorded if a TBI was present, even if ISS was relatively low (0-9 ISS group). CONCLUSION: TBI is a major element of trauma. Knowledge of the epidemiologic characteristics of the disease is imperative for adequate planning and future quality assessment.

DOI: 10.3109/02699051003789237 PMID: 20433285 [Indexed for MEDLINE]

34. Obes Surg. 2016 Jan;26(1):126-31. doi: 10.1007/s11695-015-1732-5.

“Normal Values of 24H Multichannel Intraluminal Impedance pH-Metry in a Greek Obese Population Based on Montreal Definition of Gerd”.

Doulami G(1), Triantafyllou S(2), Natoudi M(3), Albanopoulos K(3), Menenakos E(3), Filis K(4), Zografos G(4), Theodorou D(2).

Author information: (1)Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas. Sofias Av., 11527, Athens, Greece. tzinagb@yahoo.gr. (2)Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, 114 Vas. Sofias Av., 11527, Athens, Greece. (3)Department of Bariatric Surgery, 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece. (4)1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece.

BACKGROUND: Although several studies reporting normal values of 24h multichannel intraluminal impedance pH (MIIpH) have been published, none of them has ever studied obese individuals. The purpose of this study is to determine overall frequency and duration of reflux episodes (acid and non-acid, supine-upright, post and preprandial) in obese asymptomatic volunteers. METHODS: Obese volunteers were enlisted during their preoperative evaluation for bariatric surgery. Volunteers had no gastroesophageal reflux disease (GERD) symptoms and no evidence of esophageal mucosal injury on endoscopy. Participants underwent a 24h MIIpH. RESULTS: In this prospective observational study, data of 22 obese individuals were analyzed. Mean age was 41.9 years and mean BMI was 47.1 kg/m(2). Mean total reflux episodes was 55.6 and 95th percentile was 99.7. Mean percentage of total time with pH <4 was 2.59 % and 95th percentile was 8.57 %. Mean percentage of bolus exposure was 1.84 % with 95th percentile being 4.47 %. Postprandial acid reflux episodes were statistical significant more frequent in comparison to preprandial acid reflux episodes (19.41 vs. 15, p = 0.008). Mean acid clearance duration was 3.6 times higher than median bolus clearance duration (56.05 and 15.55 s, respectively, p = 0.868). CONCLUSION: Our study is the first to provide normal values of 24h MIIpH of asymptomatic obese. Normal values of 24h MIIpH of obese asymptomatic individuals differ from the reported normal values of non-obese healthy individuals; having more reflux episodes and equal or slightly higher median bolus exposure and acid clearance. Our results imply that new cut-off values should be employed in order to define GERD in obese individuals.

DOI: 10.1007/s11695-015-1732-5 PMID: 26003551 [Indexed for MEDLINE]

35. Surg Laparosc Endosc Percutan Tech. 2016 Dec;26(6):e163-e166. doi: 10.1097/SLE.0000000000000336.

Real-time Continuous Esophageal High-resolution Manometry (HRM) During Laparoscopic Heller Myotomy and Dor Fundoplication for the Treatment of Achalasia. A Promising Novelty in Regards of Perfecting Surgical Technique: Could It Guide Surgical Technique Toward Excellent Results?

Triantafyllou T(1), Doulami G, Papailiou J, Mantides A, Zografos G, Theodorou D.

Author information: (1)*Foregut Surgery Department, 1st Propaedeutic Surgical Clinic, Hippokration General Hospital of Athens, Athens †Private Practice, Athens, Greece.

High-resolution manometry (HRM) is the gold-standard diagnostic tool for achalasia of the esophagus. Laparoscopic Heller-Dor technique is the preferred surgical approach with success rate estimated 90%. The use of intraoperative HRM provides real-time estimation of intraluminal esophageal pressures and identifies the exact points of esophageal luminal pressure during laparoscopy. Ten patients with achalasia underwent surgery. All patients preoperatively completed 1 manometric study and Quality of Life questionnaires (EORTC QLQ-C30 version 3.0) with Eckardt scores. We collected intraoperative manometry data and repeated manometric studies, EORTC QLQ-C30, and Eckardt scores postoperatively. Median Eckardt score was decreased from 7.5 to 0.5, mean resting pressure decreased from 51.4 to 11.9 mm Hg, whereas mean residual pressure diminished from 45.9 to 9.5 mm Hg postoperatively. The simultaneous use of HRM during the Heller-Dor technique may lead to an individualized management of the disease.

DOI: 10.1097/SLE.0000000000000336 PMID: 27846179 [Indexed for MEDLINE]

36. Am J Case Rep. 2016 May 20;17:340-6. doi: 10.12659/ajcr.897778.

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes.

Vezakis AI(1), Pantiora EV(1), Kontis EA(1), Sakellariou V(2), Theodorou D(3), Gkiokas G(1), Polydorou AA(1), Fragulidis GP(1).

Author information: (1)2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece. (2)Department of Surgery, St Luke’s Hospital, Panorama, Greece. (3)Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, “Hippokration” General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece.

BACKGROUND: Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The extent of injuries after ingestion of caustic substances depends on the nature, amount, and concentration of the agent and on the exposure time. Acutely, caustic substances may cause massive hemorrhage and gastrointestinal tract perforation; the most markedly affected cases require urgent surgical treatment. Patients surviving the initial event may present with aorto-enteric or gastrocolic fistulae, esophageal strictures, dysphagia, and increased risk of esophageal cancer as long term sequelae. CASE REPORT: The features of three cases of caustic ingestion are reported to demonstrate significantly different complaints presented at the emergency department. Two patients had free gastric perforation, one at presentation, and one delayed. The third patient presented with late severe strictures of the esophagus and pylorus. The outcomes of the three patients are discussed in detail along with the most current management strategies. CONCLUSIONS: Among adults, ingestion of caustic substances is usually associated with more severe lesions due to the increased amount of ingested substance, as compared with pediatric patients. The most serious presentation is that of visceral perforation, most commonly of the stomach and rarely of the esophagus. Management involves urgent resuscitation with correction of fluid and electrolyte and acid-base abnormalities and immediate surgical exploration in those patients with signs of perforation. Once the perioperative period is managed successfully, the long-term results can be satisfactory. Managing of strictures or else reconstructive procedures must be well timed to allow for psychological and nutritional rehabilitation.

DOI: 10.12659/ajcr.897778 PMCID: PMC4917067 PMID: 27197994 [Indexed for MEDLINE]

37. Minerva Cardioangiol. 2016 Oct;64(5):534-41. Epub 2015 Apr 17.

The prognostic role of carotid plaque ultrasonography in cardiac damage after carotid endarterectomy: carotid plaque and cardiac risk.

Galyfos G(1), Toutouzas KP, Benetos G, Konstadoulakis M, Theodorou D, Katsaragakis S, Stefanadis C, Zografos G, Filis K.

Author information: (1)1st Department of Propedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece – georgegalyfos@hotmail.com.

BACKGROUND: This study evaluates the correlation of ultrasound determined carotid plaque morphology with coronary risk and cardiac damage after carotid endarterectomy. METHODS: Fifty patients (in a series of 162) scheduled for carotid endarterectomy had the indication for coronary CT-angiography preoperatively and were included in this study. Patients were classified according to ultrasonographic characteristics of carotid plaque. The Duke Criteria were used to assess the degree of coronary risk (low, medium and high risk). Cardiac damage after carotid endarterectomy was evaluated based on symptoms, cardiac Troponin I measurement and electrocardiographic findings. RESULTS: There were no deaths, strokes or symptomatic myocardial infarctions postoperatively (30-day results). Ten patients (20%) showed asymptomatic cardiac damage postoperatively. Cardiac damage after surgery did not show any difference between the three cardiac risk groups. Echogenic and specifically Type IV carotid artery plaques (Gray-Weale Criteria) were associated with high cardiac risk preoperatively and with postoperative cardiac damage. The degree of carotid artery stenosis, and echolucent carotid plaques were not associated with postoperative cardiac damage. CONCLUSIONS: Asymptomatic postoperative cardiac damage occurs often after carotid endarterectomy and presents independently from coronary risk. Carotid plaques of higher echogenicity are associated with severity of coronary artery disease and cardiac damage after carotid endarterectomy.

PMID: 25881874 [Indexed for MEDLINE]

38. Obes Surg. 2015 Oct;25(10):1882-5. doi: 10.1007/s11695-015-1614-x.

GERD-Related Questionnaires and Obese Population: Can They Really Reflect the Severity of the Disease and the Impact of GERD on Quality of Patients’ Life?

Doulami G(1), Triantafyllou S, Natoudi M, Albanopoulos K, Leandros E, Zografos G, Theodorou D.

Author information: (1)”Hippokration” General Hospital of Athens, 114 Vas Sofias Av, 11527, Athens, Greece, tzinagb@yahoo.gr.

INTRODUCTION: There is a strong association between obesity and gastroesophageal reflux disease (GERD). GERD-related questionnaires have been developed in order to objectify symptoms. However, none of them has been tested in obese population. PURPOSE: The purpose of this study is to evaluate if GERD score and GERD-Health-Related Quality of Life (HRQL) can reflect severity of the disease and screen obese patients for GERD preoperatively. GERD’s impact on the quality of life of obese patients is being assessed with the use of EORTC-QLQ C30. PATIENTS-METHODS: Obese patients during their preoperative evaluation were recruited regardless of the presence of GERD symptoms. A targeted GERD symptom history was obtained. Patients completed GERD score, GERD-HRQL, and EORTC-QLQ C30, and then, a 24-h multichannel intraluminal impedance pHmetry (MIIpH) was conducted. RESULTS: Forty-seven consecutive obese patients with mean age 39.91 years and mean BMI 46.94 kg/m(2) were included in the study. GERD score and GERD-HRQL have a positive linear correlation with DeMeester score (p = 0.001 and p < 0.001, respectively). EORTC QLQ-C30 does not correlate with DeMeester score. CONCLUSIONS: GERD-related questionnaires could be used in obese population as preoperative screening tool for GERD. However, our results indicate that the quality of life of obese patients is not affected by the existence of GERD.

DOI: 10.1007/s11695-015-1614-x PMID: 25708239 [Indexed for MEDLINE]

39. Am J Surg. 2008 Sep;196(3):e5-6. doi: 10.1016/j.amjsurg.2007.07.030. Epub 2008 Apr 23.

Rigler sign: an underappreciated alert for pneumoperitoneum.

Markogiannakis H(1), Fili K, Spaniolas K, Bizimi V, Katsiva V, Theodorou D.

Author information: (1)1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece. markogiannakis@easy.com

A patient presented with abdominal pain. Supine abdominal radiograph disclosed free intraperitoneal air (Rigler sign). This finding prompted further work-up and treatment.

DOI: 10.1016/j.amjsurg.2007.07.030 PMID: 18436174 [Indexed for MEDLINE]

40. Scand J Trauma Resusc Emerg Med. 2010 Mar 16;18:14. doi: 10.1186/1757-7241-18-14.

Interfacility transfers in a non-trauma system setting: an assessment of the Greek reality.

Katsaragakis S(1), Drimousis PG, Kleidi ES, Toutouzas K, Lapidakis E, Papadakis G, Daskalakis K, Larentzakis A, Theodoraki ME, Theodorou D.

Author information: (1)First Department of Propaedeutic Surgery, Surgical Intensive Care Unit, Hippocration General Hospital, Athens, Greece. skatsar@mail.gr

BACKGROUND: Quality assessment of any trauma system involves the evaluation of the transferring patterns. This study aims to assess interfacility transfers in the absence of a formal trauma system setting and to estimate the benefits from implementing a more organized structure. METHODS: The ‘Report of the Epidemiology and Management of Trauma in Greece’ is a one year project of trauma patient reporting throughout the country. It provided data concerning the patterns of interfacility transfers. We compared the transferred patient group to the non transferred patient group. Information reviewed included patient and injury characteristics, need for an operation, Intensive Care Unit (ICU) admittance and mortality. Analysis employed descriptive statistics and Chi-square test. Interfacility transfers were then assessed according to each health care facility’s availability of five requirements; Computed Tomography scanner, ICU, neurosurgeon, orthopedic and vascular surgeon. RESULTS: Data on 8,524 patients were analyzed; 86.3% were treated at the same facility, whereas 13.7% were transferred. Transferred patients tended to be younger, male, and more severely injured than non transferred patients. Moreover, they were admitted to ICU more often, had a higher mortality rate but were less operated on compared to non transferred patients. The 34.3% of transfers was from facilities with none of the five requirements, whereas the 12.4% was from those with one requirement. Low level facilities, with up to three requirements transferred 43.2% of their transfer volume to units of equal resources. CONCLUSION: Trauma management in Greece results in a high number of transfers. Patients are frequently transferred between low level facilities. Better coordination could lead to improved outcomes and less cost.

DOI: 10.1186/1757-7241-18-14 PMCID: PMC2855516 PMID: 20233409 [Indexed for MEDLINE]

41. J Med Case Rep. 2011 May 14;5:184. doi: 10.1186/1752-1947-5-184.

Intramuscular myxoma associated with an increased carbohydrate antigen 19.9 level in a woman: a case report.

Theodorou D(1), Kleidi ES, Doulami GI, Drimousis PG, Larentzakis A, Toutouzas K, Katsaragakis S.

Author information: (1)First Department of Propedeutic Surgery, University of Athens, Athens Medical School, Hippocration Hospital, Athens, Greece. tzinagb@yahoo.gr.

INTRODUCTION: Intramuscular myxoma is a rare benign soft tissue tumor. The lack of specific symptoms and widely used laboratory tests makes the diagnosis quite difficult. We present a case of an Intramuscular myxoma associated with an increased carbohydrate antigen 19.9 level. To the best of our knowledge, there have not been any reported cases of an association of Intramuscular myxoma with tumor markers in the literature. CASE PRESENTATION: A 45-year-old Caucasian woman presented to our department for resection of a mass in her left groin area, discovered incidentally on a triplex ultrasonography of her lower extremities. The diagnosis of Intramuscular myxoma was confirmed on histopathology after the complete surgical excision of the tumor. On laboratory examination, the serum level of carbohydrate antigen 19.9 was found to be elevated, but it returned to normal six months after resection of the mass. CONCLUSION: Carbohydrate antigen 19.9 is a tumor marker that increases in a variety of malignant and benign conditions. After the exclusion of all other possible reasons for carbohydrate antigen 19.9 elevation, we assumed a possible connection of carbohydrate antigen 19.9 elevation and Intramuscular myxoma, an issue that requires needs further investigation.

DOI: 10.1186/1752-1947-5-184 PMCID: PMC3108943 PMID: 21569608

42. Int J Surg Case Rep. 2016;29:16. doi: 10.1016/j.ijscr.2016.10.034. Epub 2016 Oct 27.

Corrigendum to “Esophageal remnant cancer 35 years after acidic caustic injury: A case report” [Int. J. Surg. Case Rep. 25 (2016) 215-217].

Ntanasis-Stathopoulos I(1), Triantafyllou T(2), Xiromeritou V(3), Bliouras N(2), Loizou C(2), Theodorou D(2).

Erratum for Int J Surg Case Rep. 2016;25:215-7.

DOI: 10.1016/j.ijscr.2016.10.034 PMCID: PMC5094154 PMID: 27810604

43. J Gastrointest Surg. 2008 Sep;12(9):1497-501. doi: 10.1007/s11605-008-0575-y. Epub 2008 Jul 9.

The effects of vasopressors on perfusion of gastric graft after esophagectomy. An experimental study.

Theodorou D(1), Drimousis PG, Larentzakis A, Papalois A, Toutouzas KG, Katsaragakis S.

Author information: (1)1st Department of Propaedeutic Surgery, Athens Medical School, University of Athens, Hippocration General Hospital of Athens, Athens, Greece.

Comment in J Gastrointest Surg. 2009 May;13(5):1019; author reply 1020.

AIMS: To evaluate the impact of the perioperative administration of norepinephrine on the perfusion of the esophageal graft. METHODS: This is an experimental study. Six swine underwent transhiatal esophagectomy; the stomach was used to replace the resected esophagus. We provoked hemorrhagic shock to the animals and then we administered noradrenaline to restore the blood pressure. We monitored the graft perfusion perioperatively using the technique of microdialysis. RESULTS: In all animals, the graft experienced severe hypoperfusion after the administration of noradrenaline that was statistically significant. CONCLUSIONS: Our data support the hypothesis that norepinephrine should be used with extreme caution in the perioperative setting after esophagectomy. Further studies, however, will be required to evaluate the clinical significance of this finding.

DOI: 10.1007/s11605-008-0575-y PMID: 18612706 [Indexed for MEDLINE]

44. Neth J Med. 2008 Apr;66(4):154-9.

Preoperative levosimendan in heart failure patients undergoing noncardiac surgery.

Katsaragakis S(1), Kapralou A, Markogiannakis H, Kofinas G, Theodoraki EM, Larentzakis A, Menenakos E, Theodorou D.

Author information: (1)Department of Surgical Intensive Care Unit, First Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece.

BACKGROUND: Heart failure (HF) is a major cause of perioperative morbidity and mortality in noncardiac surgery. Preoperative optimisation of these patients is, thus, of utmost importance. Levosimendan seems promising for patients undergoing cardiac surgery; however, its safety and efficacy in HF patients undergoing noncardiac surgery have not been evaluated. OBJECTIVE: To evaluate the effects of prophylactic preoperative levosimendan administration on left ventricular function in HF patients undergoing noncardiac surgery. METHODS: HF patients with ejection fraction <30%undergoing elective noncardiac surgery in 2005 were included in this prospective study. Patients were admitted to our surgical intensive care unit one day preoperatively. Under continuous haemodynamic monitoring, the treatment protocol consisted of an initial loading dose (24 microg/kg) for ten minutes followed by a continuous 24-hour infusion (0.1 microg/kg/min) at the end of which patients underwent surgery. Echocardiography was performed before infusion (day 0) and on the 7th postinfusion day (day 7). Measurements included left ventricular ejection fraction (LVEF), velocity time integral(VTI), pre-ejection period (PEP), ejection time (ET),maximum (Pmax) and minimum P(min) transvalvular aortic pressure gradient, and maximum (Vmax) and minimum V(min) aortic velocity. RESULTS: Twelve consecutive patients were enrolled. Levosimendan resulted in a significant increase in LVEF,VTI, P(max), P(min), V(max), and V(min) (p<0.01) and, moreover, a significant reduction in PEP, ET, and PEP/ET (p=0.04) on day 7 compared with day 0 values. No adverse reactions,complications or mortality occurred during 30-day follow-up. CONCLUSION: Prophylactic preoperative levosimendan treatment may be safe and efficient for perioperative optimisation of heart failure patients undergoing noncardiac surgery.

PMID: 18424862 [Indexed for MEDLINE]

45. Cases J. 2008 Aug 18;1(1):98. doi: 10.1186/1757-1626-1-98.

Adenocarcinoma of the third and fourth portion of the duodenum: a case report and review of the literature.

Markogiannakis H(1), Theodorou D, Toutouzas KG, Gloustianou G, Katsaragakis S, Bramis I.

Author information: (1)1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical, School, University of Athens, Q, Sofias 114 av,, 11527, Athens, Greece. markogiannakis@yahoo.com.

A 65-year-old woman presented with abdominal pain, weight loss, fatigue, and microcytic anemia. Esophagogastroduodenoscopy, until the second part of duodenum, was normal. Ultrasound and computed tomography demonstrated a solid mass in the distal duodenum. A repeat endoscopy confirmed an ulcerative, intraluminar mass in the third and fourth part of the duodenum. Segmental resection of the third and fourth portion of the duodenum was performed. Histology revealed an adenocarcinoma. On the 4th postoperative day, the patient developed severe acute pancreatitis leading to multiple organ failure and died on the 30th postoperative day.

DOI: 10.1186/1757-1626-1-98 PMCID: PMC2527500 PMID: 18706123

46. Eur J Cardiothorac Surg. 2006 Apr;29(4):591-5. doi: 10.1016/j.ejcts.2005.12.027. Epub 2006 Feb 14.

The degree of oxidative stress is associated with major adverse effects after lung resection: a prospective study.

Misthos P(1), Katsaragakis S, Theodorou D, Milingos N, Skottis I.

Author information: (1)First Thoracic Surgical Department, “SOTIRIA” General Hospital for Chest Diseases, Athens, Greece. pamnisthos@yahoo.gr

Comment in Eur J Cardiothorac Surg. 2006 Aug;30(2):412-3; author reply 413. Eur J Cardiothorac Surg. 2006 Sep;30(3):568-9; author reply 569-70.

OBJECTIVE: This prospective randomized study was conducted in order to define the contribution of the generated oxygen and nitrogen reactive species on postlobectomy morbidity and mortality. PATIENTS AND METHODS: Between 2001 and 2003, 132 patients with non-small cell lung cancer (NSCLC) were prospectively studied. The patients were grouped according to one-lung ventilation (OLV) use or not and to the duration of lung’s atelectasis. Group A included 50 patients with confirmed non-small cell lung cancer who were subjected to lobectomy without one-lung ventilation. Group B included 30 patients subjected to 60 min OLV. Group C included 30 patients subjected to 90 min OLV. Group D included 22 patients subjected to 120 min OLV. Preoperative, intraoperative and postoperative strict blood sampling protocol was followed. Malondialdehyde (MDA) plasma levels were measured. The groups were statistically compared for the occurrence of postoperative complications. OLV (groups B-D) along with other clinical parameters were entered in multivariate analysis as risk factors for complication development. MEASUREMENTS AND RESULTS: Comparison of group A with groups B-D (OLV) documented significant increase (p<0.001) of MDA levels during lung reexpansion. The magnitude of oxidative stress was related to OLV duration (group D>group C>group B, all p<0.001). Univariate analysis disclosed a higher incidence of acute respiratory failure, cardiac arrhythmias and pulmonary hypertension in group D. Multivariate analysis revealed OLV as an independent risk factor for postoperative development of cardiac arrhythmias and pulmonary hypertension. CONCLUSION: Protracted (>1h) OLV should be considered a potential cause for cardiovascular complications through the generation of severe oxidative stress due to lung reexpansion.

DOI: 10.1016/j.ejcts.2005.12.027 PMID: 16476542 [Indexed for MEDLINE]

47. Resuscitation. 2011 Feb;82(2):180-4. doi: 10.1016/j.resuscitation.2010.10.005. Epub 2010 Nov 30.

Advanced Trauma Life Support certified physicians in a non trauma system setting: is it enough?

Drimousis PG(1), Theodorou D, Toutouzas K, Stergiopoulos S, Delicha EM, Giannopoulos P, Larentzakis A, Katsaragakis S.

Author information: (1)1st Department of Propaedeutic Surgery, Athens Medical School, Hippocration Hospital, Athens, Greece. pdrimousis@hotmail.com

Comment in Resuscitation. 2011 Oct;82(10):1356; author reply 1356-7.

OBJECTIVE: The purpose of this study was to evaluate the impact of ATLS(®) on trauma mortality in a non-trauma system setting. ATLS represents a fundamental element of trauma training in every trauma curriculum. Nevertheless, there are limited studies in the literature as for the impact of ATLS training in trauma mortality, especially outside the US. DESIGN: This is a prospective observational study. The primary end point was to investigate factors that affect mortality of trauma patients in our health care system. We performed a multivariate analysis for this purpose and we identified ATLS certification as a predictor of overall mortality. Following this finding we stratified patients according to the severity of injury as expressed by the ISS score and we compared outcome between those treated by an ATLS certified physician and those treated by non-certified ones. MAIN OUTCOME MEASURES: Trauma volume and demographics of trauma patients, factors that affect mortality of traumatized patients and mortality between patients treated by ATLS(®) certified and non-certified physicians. RESULTS: In total, 8862 trauma patients were included in the analysis. The majority of trauma patients (5988, 67.6%) were treated by a general surgeon, followed by those treated by an orthopedic surgeon (2194, 24.8%). There were 446 deaths in the registry but, 260 arrived dead in the Emergency Department and were excluded from the analysis. Multivariate analysis of the 186 deaths that occurred in the hospital revealed age, high ISS score, low GCS score, urban location of injury, neck injury and ATLS(®) certification as factors predisposing to mortality. Cross tabulation of ATLS(®) certification and ISS of the trauma patients shows that those treated by certified physicians died more often in all subcategories of ISS score (p<0.05). CONCLUSIONS: In Greece, with no formal trauma system implementation, ATLS(®) certified physicians achieve worse outcomes than their non-certified colleagues when managing trauma patients. We believe that these findings must be interpreted in the context of the National health care system. There is considerable room for improvement in our country, and further analysis is required.

DOI: 10.1016/j.resuscitation.2010.10.005 PMID: 21122975 [Indexed for MEDLINE]

48. Eur J Surg Oncol. 2021 Jan 1:S0748-7983(20)31225-7. doi: 10.1016/j.ejso.2020.12.006. Online ahead of print.

Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study.

Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative: Writing Committee; Steering Committee; National Leads; Site Leads; Collaborators.

Collaborators: Kamarajah SK(1), Nepogodiev D(2), Bekele A(3), Cecconello I(4), Evans RPT(1), Guner A(5), Gossage JA(6), Harustiak T(7), Hodson J(1), Isik A(8), Kidane B(9), Leon-Takahashi AM(10), Mahendran HA(11), Negoi I(12), Okonta KE(13), Rosero G(14), Sayyed RH(15), Singh P(16), Takeda FR(4), van Hillegersberg R(17), Vohra RS(18), White RE(19), Griffiths EA(20), Alderson D(21), Bundred J(1), Evans RPT(1), Gossage J(6), Griffiths EA(1), Jefferies B(1), Kamarajah SK(1), McKay S(1), Mohamed I(1), Nepogodiev D(2), Siaw-Acheampong K(1), Singh P(16), van Hillegersberg R(17), Vohra R(18), Wanigasooriya K(1), Whitehouse T(1), Gjata A(22), Moreno JI(23), Takeda FR(4), Kidane B(9), Guevara CR(24), Harustiak T(7), Bekele A(3), Kechagias A(25), Gockel I(26), Kennedy A(27), Da Roit A(28), Bagajevas A(29), Azagra JS(30), Mahendran HA(11), Mejía-Fernández L(31), Wijnhoven BPL(32), El Kafsi J(33), Sayyed RH(15), Sousa M(34), Sampaio AS(34), Negoi I(12), Blanco R(35), Wallner B(36), Schneider PM(37), Hsu PK(38), Isik A(8), Gananadha S(39), Wills V(40), Devadas M(41), Duong C(42), Talbot M(43), Hii MW(44), Jacobs R(45), Andreollo NA(46), Johnston B(47), Darling G(48), Isaza-Restrepo A(49), Rosero G(14), Arias-Amézquita F(50), Raptis D(51), Gaedcke J(52), Reim D(53), Izbicki J(54), Egberts JH(55), Dikinis S(56), Kjaer DW(57), Larsen MH(58), Achiam MP(59), Saarnio J(60), Theodorou D(61), Liakakos T(62), Korkolis DP(63), Robb WB(64), Collins C(65), Murphy T(66), Reynolds J(67), Tonini V(68), Migliore M(69), Bonavina L(70), Valmasoni M(71), Bardini R(72), Weindelmayer J(73), Terashima M(74), White RE(19), Alghunaim E(75), Elhadi M(76), Leon-Takahashi AM(10), Medina-Franco H(77), Lau PC(78), Okonta KE(79), Heisterkamp J(80), Rosman C(81), van Hillegersberg R(17), Beban G(33), Babor R(82), Gordon A(83), Rossaak JI(84), Pal KMI(85), Qureshi AU(86), Naqi SA(87), Syed AA(88), Barbosa J(89), Vicente CS(90), Leite J(91), Freire J(92), Casaca R(34), Costa RCT(93), Scurtu RR(94), Mogoanta SS(95), Bolca C(96), Constantinoiu S(97), Sekhniaidze D(98), Bjelović M(99), So JBY(100), Gačevski G(101), Loureiro C(102), Pera M(103), Bianchi A(104), Moreno GM(105), Martín Fernández J(106), Trugeda Carrera MS(35), Vallve-Bernal M(107), Cítores Pascual MA(108), Elmahi S(109), Halldestam I(110), Hedberg J(111), Mönig S(112), Gutknecht S(113), Tez M(114), Guner A(115), Tirnaksiz MB(116), Colak E(117), Sevinç B(118), Hindmarsh A(119), Khan I(120), Khoo D(121), Byrom R(122), Gokhale J(123), Wilkerson P(124), Jain P(125), Chan D(126), Robertson K(127), Iftikhar S(128), Skipworth R(129), Forshaw M(130), Higgs S(131), Gossage J(132), Nijjar R(133), Viswanath YKS(134), Turner P(135), Dexter S(136), Boddy A(137), Allum WH(138), Oglesby S(139), Cheong E(140), Beardsmore D(141), Vohra R(142), Maynard N(143), Berrisford R(144), Mercer S(145), Puig S(146), Melhado R(147), Kelty C(148), Underwood T(149), Dawas K(150), Lewis W(151), Al-Bahrani A(152), Bryce G(153), Thomas M(154), Arndt AT(155), Palazzo F(156), Meguid RA(157), Fergusson J(39), Beenen E(39), Mosse C(39), Salim J(39), Cheah S(40), Wright T(40), Cerdeira MP(40), McQuillan P(40), Richardson M(41), Liem H(41), Spillane J(42), Yacob M(42), Albadawi F(42), Thorpe T(42), Dingle A(42), Cabalag C(42), Loi K(43), Fisher OM(43), Ward S(44), Read M(44), Johnson M(44), Bassari R(45), Bui H(45), Cecconello I(158), Sallum RAA(158), da Rocha JRM(158), Lopes LR(46), Tercioti V Jr(46), Coelho JD(46), Ferrer JAP(46), Buduhan G(159), Tan L(159), Srinathan S(159), Shea P(47), Yeung J(48), Allison F(48), Carroll P(48), Vargas-Barato F(49), Gonzalez F(49), Ortega J(49), Nino-Torres L(49), Beltrán-García TC(49), Castilla L(14), Pineda M(14), Bastidas A(50), Gómez-Mayorga J(50), Cortés N(50), Cetares C(50), Caceres S(50), Duarte S(50), Pazdro A(160), Snajdauf M(160), Faltova H(160), Sevcikova M(160), Mortensen PB(56), Katballe N(57), Ingemann T(57), Morten B(57), Kruhlikava I(57), Ainswort AP(58), Stilling NM(58), Eckardt J(58), Holm J(59), Thorsteinsson M(59), Siemsen M(59), Brandt B(59), Nega B(161), Teferra E(161), Tizazu A(161), Kauppila JH(60), Koivukangas V(60), Meriläinen S(60), Gruetzmann R(51), Krautz C(51), Weber G(51), Golcher H(51), Emons G(162), Azizian A(162), Ebeling M(162), Niebisch S(163), Kreuser N(163), Albanese G(163), Hesse J(163), Volovnik L(53), Boecher U(53), Reeh M(54), Triantafyllou S(61), Schizas D(62), Michalinos A(62), Mpali E(62), Mpoura M(62), Charalabopoulos A(62), Manatakis DK(63), Balalis D(63), Bolger J(64), Baban C(64), Mastrosimone A(64), McAnena O(65), Quinn A(65), Ó Súilleabháin CB(66), Hennessy MM(66), Ivanovski I(66), Khizer H(66), Ravi N(67), Donlon N(67), Cervellera M(68), Vaccari S(68), Bianchini S(68), Sartarelli L(68), Asti E(70), Bernardi D(70), Merigliano S(164), Provenzano L(164), Scarpa M(72), Saadeh L(72), Salmaso B(72), De Manzoni G(73), Giacopuzzi S(73), La Mendola R(73), De Pasqual CA(73), Tsubosa Y(74), Niihara M(74), Irino T(74), Makuuchi R(74), Ishii K(74), Mwachiro M(19), Fekadu A(19), Odera A(19), Mwachiro E(19), AlShehab D(75), Ahmed HA(76), Shebani AO(76), Elhadi A(76), Elnagar FA(76), Elnagar HF(76), Makkai-Popa ST(165), Wong LF(78), Tan YR(166), Thannimalai S(166), Ho CA(166), Pang WS(166), Tan JH(166), Basave HNL(10), Cortés-González R(31), Lagarde SM(32), van Lanschot JJB(32), Cords C(32), Jansen WA(80), Martijnse I(80), Matthijsen R(80), Bouwense S(81), Klarenbeek B(81), Verstegen M(81), van Workum F(81), Ruurda JP(17), van der Sluis PC(17), de Maat M(17), Evenett N(33), Johnston P(33), Patel R(33), MacCormick A(82), Young M(83), Smith B(84), Ekwunife C(79), Memon AH(85), Shaikh K(85), Wajid A(85), Khalil N(86), Haris M(86), Mirza ZU(86), Qudus SBA(86), Sarwar MZ(87), Shehzadi A(87), Raza A(87), Jhanzaib MH(87), Farmanali J(15), Zakir Z(15), Shakeel O(88), Nasir I(88), Khattak S(88), Baig M(88), Noor MA(88), Ahmed HH(88), Naeem A(88), Pinho AC(90), da Silva R(90), Bernardes A(91), Campos JC(91), Matos H(92), Braga T(92), Monteiro C(34), Ramos P(34), Cabral F(34), Gomes MP(92), Martins PC(92), Correia AM(92), Videira JF(92), Ciuce C(93), Drasovean R(93), Apostu R(93), Ciuce C(93), Paitici S(94), Racu AE(94), Obleaga CV(94), Beuran M(12), Stoica B(12), Ciubotaru C(12), Negoita V(12), Cordos I(95), Birla RD(96), Predescu D(96), Hoara PA(96), Tomsa R(96), Shneider V(97), Agasiev M(97), Ganjara I(97), Gunjić D(98), Veselinović M(98), Babič T(98), Chin TS(100), Shabbir A(100), Kim G(100), Crnjac A(101), Samo H(101), Díez Del Val I(102), Leturio S(102), Ramón JM(103), Dal Cero M(103), Rifá S(103), Rico M(103), Pagan Pomar A(104), Martinez Corcoles JA(104), Rodicio Miravalles JL(105), Pais SA(105), Turienzo SA(105), Alvarez LS(105), Campos PV(106), Rendo AG(106), García SS(106), Santos EPG(106), Martínez ET(35), Fernández DM(35), Magadán ÁC(35), Concepción MV(107), Díaz LC(107), Rosat RA(107), Pérez SL(107), Bailón CM(108), Tinoco CC(108), Choolani Bhojwani E(108), Sánchez DP(108), Ahmed ME(109), Dzhendov T(110), Lindberg F(36), Rutegård M(36), Sundbom M(111), Mickael C(112), Colucci N(112), Schnider A(113), Er S(114), Kurnaz E(167), Turkyilmaz S(115), Turkyilmaz A(115), Yildirim R(115), Baki BE(115), Akkapulu N(116), Karahan O(118), Damburaci N(118), Hardwick R(119), Safranek P(119), Sujendran V(119), Bennett J(119), Afzal Z(119), Shrotri M(120), Chan B(120), Exarchou K(120), Gilbert T(120), Amalesh T(121), Mukherjee D(121), Mukherjee S(121), Wiggins TH(121), Kennedy R(168), McCain S(168), Harris A(168), Dobson G(168), Davies N(122), Wilson I(122), Mayo D(122), Bennett D(122), Young R(123), Manby P(123), Blencowe N(124), Schiller M(124), Byrne B(124), Mitton D(125), Wong V(125), Elshaer A(125), Cowen M(125), Menon V(126), Tan LC(126), McLaughlin E(126), Koshy R(126), Sharp C(127), Brewer H(128), Das N(128), Cox M(128), Al Khyatt W(128), Worku D(128), Iqbal R(129), Walls L(129), McGregor R(129), Fullarton G(130), Macdonald A(130), MacKay C(130), Craig C(130), Dwerryhouse S(131), Hornby S(131), Jaunoo S(131), Wadley M(131), Baker C(132), Saad M(132), Kelly M(132), Davies A(132), Di Maggio F(132), McKay S(133), Mistry P(133), Singhal R(133), Tucker O(133), Kapoulas S(133), Powell-Brett S(133), Davis P(134), Bromley G(134), Watson L(134), Verma R(135), Ward J(135), Shetty V(135), Ball C(135), Pursnani K(135), Sarela A(136), Sue LH(136), Mehta S(136), Hayden J(136), To N(136), Palser T(137), Hunter D(137), Supramaniam K(137), Butt Z(137), Ahmed A(137), Kumar S(138), Chaudry A(138), Moussa O(138), Kordzadeh A(169), Lorenzi B(169), Wilson M(139), Patil P(139), Noaman I(139), Willem J(140), Bouras G(141), Evans R(141), Singh M(141), Warrilow H(141), Ahmad A(141), Tewari N(142), Yanni F(142), Couch J(142), Theophilidou E(142), Reilly JJ(142), Singh P(142), van Boxel G(143), Akbari K(143), Zanotti D(143), Sgromo B(143), Sanders G(144), Wheatley T(144), Ariyarathenam A(144), Reece-Smith A(144), Humphreys L(144), Choh C(145), Carter N(145), Knight B(145), Pucher P(145), Athanasiou A(146), Mohamed I(146), Tan B(146), Abdulrahman M(146), Vickers J(147), Akhtar K(147), Chaparala R(147), Brown R(147), Alasmar MMA(147), Ackroyd R(148), Patel K(148), Tamhankar A(148), Wyman A(148), Walker R(149), Grace B(149), Abbassi N(150), Slim N(150), Ioannidi L(150), Blackshaw G(151), Havard T(151), Escofet X(151), Powell A(151), Owera A(152), Rashid F(152), Jambulingam P(152), Padickakudi J(152), Ben-Younes H(153), Mccormack K(153), Makey IA(154), Karush MK(155), Seder CW(155), Liptay MJ(155), Chmielewski G(155), Rosato EL(156), Berger AC(156), Zheng R(156), Okolo E(156), Singh A(157), Scott CD(157), Weyant MJ(157), Mitchell JD(157).

Author information: (1)Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK. (2)NIHR Global Surgery Research Unit, University of Birmingham, Birmingham, UK. (3)University of Global Health Equity, Kigali, Rwanda. (4)University of São Paulo, São Paulo, Brazil. (5)Department of General Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey. (6)Guy’s and St Thomas’ Esophago-Gastric Research Group, London, UK. (7)3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic. (8)Department of General Surgery, School of Medicine, Erzincan University, Erzincan, Turkey. (9)Section of Thoracic Surgery, Health Sciences Centre, Winnipeg, Manitoba, Canada. (10)National Cancer Institute, Mexico. (11)Hospital Sultanah Aminah, Johor Bahru, Malaysia. (12)Emergency Hospital of Bucharest, Romania. (13)Carez Clinic, Nigeria. (14)Hospital San Ignacio-Universidad Javeriana, Colombia. (15)Patel Hospital, Pakistan. (16)Regional Oesophagogastric Cancer Unit, Royal Surrey County Hospital, Guildford, UK. (17)UMC, Utrecht, Netherlands. (18)Nottingham University Hospital, Nottingham, UK. (19)Tenwek Hospital, Kenya. (20)Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK. Electronic address: ewenagriffiths@gmail.com. (21)Royal College of Surgeons, London, UK. (22)University Hospital Center ‘Mother Teresa’, Albania. (23)Hospital Italiano Rosario, Argentina. (24)Clínica Universitaria Colombia, Colombia. (25)Tampere University Hospital, Finland. (26)University of Leipzig, Germany. (27)Belfast City Hospital, Ireland. (28)Policlynic Hospital University of Bari, Italy. (29)Klaipeda University Hospital, Lithuania. (30)Centre Hospitalier de Luxembourg, Luxembourg. (31)Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Mexico. (32)Erasmus University Medical Center, Rotterdam, Netherlands. (33)Auckland City Hospital, New Zealand. (34)Instituto Português de Oncologia de Lisboa, Portugal. (35)Hospital Universitario Marqués de Valdecilla, Spain. (36)Umeå University Hospital, Sweden. (37)Hirslanden Medical Center, Switzerland. (38)Taipei Veterans General Hospital, Taiwan. (39)The Canberra Hospital, Australia. (40)John Hunter Hospital, Australia. (41)Nepean Hospital, Australia. (42)Peter MacCallum Cancer Center, Australia. (43)St George Public and Private Hospitals, Australia. (44)St Vincent’s Hospital Melbourne, Australia. (45)Western Hospital, Victoria, Australia. (46)Unicamp University Hospital, Brazil. (47)Saint John Regional Hospital, Canada. (48)Toronto General Hospital, University Health Network, Canada. (49)Hospital Universitario Mayor Mederi-Universidad del Rosario, Colombia. (50)University Hospital Fundacion Santafe de Bogota, Colombia. (51)University Clinic of Erlangen, Germany. (52)Medical Uinversity Goettingen, Germany. (53)Klinikum Rechts der Isar der TU München, Germany. (54)University Hospital Hamburg Eppendorf, Germany. (55)University Hospital Kiel, Germany. (56)Aalborg University Hospital, Denmark. (57)Aarhus University Hospital, Denmark. (58)Odense University Hospital, Denmark. (59)Copenhagen University Hospital Rigshospitalet, Denmark. (60)Oulu University Hospital, Finland. (61)Hippokration General Hospital University of Athens, Greece. (62)Laikon General Hospital, Greece. (63)St. Savvas Cancer Hospital, Greece. (64)Beaumont Hospital, Ireland. (65)University Hospital Galway, Ireland. (66)Mercy University Hospital, Ireland. (67)St James’s Hospital, Dublin, Ireland. (68)St. Orsola Hospital- University of Bologna, Italy. (69)Polyclinic Hospital University of Catania, Italy. (70)University of Milano, IRCCS Policlinico San Donato, Department of General and Foregut Surgery, Italy. (71)Padova University Hospital – Clinica Chirurgica 3, Italy. (72)Padova University Hospital- General Surgery Department, Italy. (73)Verona Borgo Trento Hospital, Italy. (74)Shizioka Cancer Center, Japan. (75)Chest Diseases Hospital, Kuwait. (76)Tripoli, Libya. (77)National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico. (78)University Malaya Medical Center, Malaysia. (79)Carez Hospital & University of Port-Harcourt Teaching Hospital, Nigeria. (80)Elisabeth-TweeSteden Ziekenhuis Hospital, Netherlands. (81)Radboudumc, Netherlands. (82)Middlemore Hospital, New Zealand. (83)Palmerston North Hospital, New Zealand. (84)Tauranga Hospital, Bay of Plenty District Health Board, New Zealand. (85)Aga Khan University Hospital, Pakistan. (86)Services Institute of Medical Sciences, Lahore, Pakistan. (87)Mayo Hospital, Lahore, Pakistan. (88)Shaukat Khanum Memorial Cancer Hospital & Research Center Lahore, Pakistan. (89)Centro Hospitalar São João, Portugal. (90)Centro Hospitalar Lisboa Central, Portugal. (91)Coimbra University Hospital, Portugal. (92)Hospital Santa Maria, Portugal. (93)Instituto Português de Oncologia do Porto, Portugal. (94)University Emergency Cluj County Hospital, Romania. (95)Emergency County Hospital of Craiova, Romania. (96)Marius Nasta’ National Institute of Pneumology, Romania. (97)St. Mary Clinical Hospital, Romania. (98)Tyumen Regional Hospital, Russia. (99)Department for Minimally Invasive Upper Digestive Surgery, University Hospital for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia. (100)National University Hospital, Singapore. (101)University Hospital Maribor, Slovenia. (102)University Hospital of Basurto Bilbao, Spain. (103)Hospital Universitario del Mar, Spain. (104)Palma de Mallorca, Spain. (105)Hospital Universitario Central de Asturias, Spain. (106)Hospital General Universitario De Ciudad Real, Spain. (107)Hospital Universitario Nuestra Señora de Candelaria, Spain. (108)Hospital Universitario Río Hortega de Valladolid, Spain. (109)Shaab Teaching Hospital, Sudan. (110)University Hospital Linköping, Sweden. (111)Uppsala University Hospital, Sweden. (112)Geneva University Hospital, Switzerland. (113)Triemli Hospital Zurich, Switzerland. (114)Ankara Numune Hospital, Turkey. (115)Karadeniz Technical University, Turkey. (116)Hacettepe University Hospital, Turkey. (117)University of Health Sciences, Samsun Training and Research Hospital, Turkey. (118)Usak University Training and Research Hospital, Turkey. (119)Addenbrooke’s Hospital, Cambridge, UK. (120)Aintree University Hospital, Liverpool, UK. (121)Barking Havering and Redbridge NHS Trust, UK. (122)Royal Bournemouth Hospital, UK. (123)Bradford Royal Infirmary, UK. (124)University Hospitals Bristol NHS Foundation Trust, UK. (125)Castle Hill Hospital, UK. (126)University Hospital of Coventry, UK. (127)University Hospital Crosshouse, UK. (128)Royal Derby Hospital, UK. (129)Edinburgh Royal Infirmary, UK. (130)Glasgow Royal Infirmary, UK. (131)Gloucester Royal Hospital, UK. (132)Guy’s and St Thomas’s Hospitals, UK. (133)Heartlands Hospital, UK. (134)James Cook University Hospital, UK. (135)Lancashire Teaching Hospitals NHS Foundation Trust, UK. (136)Leeds Teaching Hospitals NHS Trust, UK. (137)University Hospitals of Leicester NHS Trust, UK. (138)Royal Marsden Hospital, UK. (139)Ninewells Hospital, UK. (140)Norfolk and Norwich University Hospital, UK. (141)University Hospital of North Midlands, UK. (142)Nottingham University Hospital, UK. (143)Oxford University Hospitals, UK. (144)Plymouth Hospitals NHS Trust, UK. (145)Queen Alexandra Hospital, Portsmouth, UK. (146)Queen Elizabeth Hospital Birmingham, UK. (147)Salford Royal Foundation Trust, UK. (148)Sheffield Teaching Hospitals NHS Foundation Trust, UK. (149)University Hospital Southampton NHS Foundation Trust, UK. (150)University College Hospital, UK. (151)University Hospital of Wales, UK. (152)Watford General Hospital, UK. (153)University Hospital Wishaw, UK. (154)Mayo Clinic in Florida, USA. (155)Rush University Medical Center, USA. (156)Thomas Jefferson University, USA. (157)University of Colorado Hospital, USA. (158)Hospital das Clinicas, University of Sao Paulo School of Medicine, Brazil. (159)Health Sciences Center Winnipeg, Canada. (160)Motol University Hospital, Prague, Czech Republic. (161)Tikur Anbessa Specialized Hospital, Ethiopia. (162)Medical University Goettingen, Germany. (163)Universitätklinium Leipzig, Germany. (164)Padova University Hospital – Clinica Chirurgica, Italy. (165)Center Hospitalier de Luxembourg, Luxembourg. (166)Hospital Sultanah Aminah, Malaysia. (167)Erzincan University Hospital, Turkey. (168)Belfast City Hospital, UK. (169)Mid and South Essex NHS Foundation Trust, UK.

BACKGROUND: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. METHOD: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III – V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). RESULTS: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. CONCLUSION: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.

DOI: 10.1016/j.ejso.2020.12.006 PMID: 33451919

Conflict of interest statement: Declaration of competing interest None declared.

49. Langenbecks Arch Surg. 2012 Jan;397(1):143; author reply 143-4. doi: 10.1007/s00423-011-0814-7. Epub 2011 Jul 15.

Letter to the editor regarding the experimental study of Adas et al.: Mesenchymal stem cells improve the healing of ischemic colonic anastomoses.

Larentzakis A, Paparountas T, Theodorou D.

Comment on Langenbecks Arch Surg. 2011 Jan;396(1):115-26.

DOI: 10.1007/s00423-011-0814-7 PMID: 21755433 [Indexed for MEDLINE]

50. Resuscitation. 2009 Mar;80(3):350-3. doi: 10.1016/j.resuscitation.2008.10.015. Epub 2009 Jan 20.

Emergency room management of trauma patients in Greece: preliminary report of a national study.

Theodorou D(1), Toutouzas K, Drimousis P, Larentzakis A, Kleidi E, Georgiou G, Gymnopoulos D, Kandylakis S, Theodoraki ME, Katsaragakis S.

Author information: (1)Surgical Intensive Care Unit, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital, Athens Medical School, Greece. dtheodorou@hippocratio.gr

AIM OF THE STUDY: The aim of this study was to record and to evaluate the epidemiology of trauma in Greece and to assess the quality of management provided for trauma patients in the emergency department in Greek hospitals. METHODS: The Hellenic Society of Trauma and Emergency Surgery invited all the official representatives of the society throughout the country to participate in the study. The representatives that responded positively, met with the Board of the society in succeeding meetings to establish the reporting form and the inclusion criteria. Inclusion criteria were defined as trauma patients requiring admission, transfer to a higher level center or arrived dead or died in the emergency department of the reporting hospital. All reports were accumulated by the Hellenic Trauma society, imported in an electronic data base and analyzed. The design of the study was prospective and observational. RESULTS: In total 8862 patients were included in the study in 12 months time. Of them 68.7% (n=6084) were male, aged 41.8+/-20.6 (mean+/-S.D.) and 31.3% were female (n=2778), aged 52.7+/-24.1 (mean+/-S.D.). The mean duration of treatment in the emergency room department was 1h and 28min. Of the total number of patients, 2312 (26.1%) were initially assessed and managed by a specialist and 6249 (70.5%) were initially assessed and managed by a resident. CONCLUSIONS: Data from this study show that there is substantial room for improvement in the patient care in the emergency department following trauma. Further evaluation will be required to identify particular management patterns that can be readily altered.

DOI: 10.1016/j.resuscitation.2008.10.015 PMID: 19157674 [Indexed for MEDLINE]

51. Endoscopy. 2007 Feb;39 Suppl 1:E195. doi: 10.1055/s-2007-966416. Epub 2007 Jul 5.

Bilateral pneumothorax following endoscopic retrograde cholangiopancreatography: a case report.

Markogiannakis H(1), Toutouzas KG, Pararas NV, Romanos A, Theodorou D, Bramis I.

Author information: (1)1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece. markogiannakis@easy.com

DOI: 10.1055/s-2007-966416 PMID: 17614062 [Indexed for MEDLINE]

52. J Trauma. 2009 Dec;67(6):1421-5. doi: 10.1097/TA.0b013e31818961a9.

The implementation of a national trauma registry in Greece. Methodology and preliminary results.

Katsaragakis S(1), Theodoraki ME, Toutouzas K, Drimousis PG, Larentzakis A, Stergiopoulos S, Aggelakis C, Lapidakis G, Massalis I, Theodorou D.

Author information: (1)Surgical Intensive Care Unit, 1st Propaedeutic Surgical Clinic, Hippocration General Hospital, Athens Medical School, Athens, Greece.

BACKGROUND: Trauma is a leading cause of death worldwide and a major health problem of the modern society. Trauma systems are considered the gold standard of managing patients with trauma. An integral part of any trauma system is a trauma registry. In Europe, and particularly in Greece, trauma registries and systems are in an embryonic stage. In this study, we present an attempt to record trauma in Greece. METHODS: The Hellenic Society of Trauma and Emergency Surgery invited all the official representatives of the society throughout the country to participate in the study. In succeeding meetings of the representatives, the reporting form was developed and the inclusion criteria were defined meticulously. Inclusion criteria were defined as patients with trauma requiring admission, transfer to a higher level center, or arrived dead or died in the emergency department of the reporting hospital. All reports were accumulated by the Hellenic Trauma society, imported in an electronic database, and analyzed. RESULTS: Thirty-two hospitals receiving patients with trauma participated in the country, representing 40% of the country’s healthcare facilities and serving 40% of the country’s population. In 12 months time, (October 2005 to September 2006), 8,862 patients were included in the study. Of them, 66.9% were men and 31.3% were women. The compilation rate of the reporting forms was surprisingly high, considering that the final reporting form included 150 data points and that there were no independent personnel in charge of filling the forms. CONCLUSIONS: Trauma registries are feasible even in health care systems where funding of medical research is sparse.

DOI: 10.1097/TA.0b013e31818961a9 PMID: 20009696 [Indexed for MEDLINE]

53. Saudi J Anaesth. 2012 Oct-Dec;6(4):373-9. doi: 10.4103/1658-354X.105870.

Combined general-epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair.

Panaretou V(1), Siafaka I, Theodorou D, Manouras A, Seretis C, Gourgiotis S, Katsaragakis S, Sigala F, Zografos G, Filis K.

Author information: (1)Department of Anesthesiology, “Hippokration”, Vascular Surgery Unit, University of Athens Medical School, “Hippokration” Hospital of Athens, Athens, Greece.

BACKGROUND: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. METHODS: THIRTY PATIENTS, SCHEDULED TO UNDERGO AN ELECTIVE INFRARENAL ABDOMINAL AORTIC RECONSTRUCTIVE PROCEDURE WERE RANDOMIZED IN TWO GROUPS: the epidural anesthesia group (Group A, n=16) and the control group (Group B, n=14). After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO2 levels and the calculation of regional-arterial CO2 difference (ΔPCO2). Additional measurements included mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), and arterial lactate levels. RESULTS: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. CONCLUSIONS: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results.

DOI: 10.4103/1658-354X.105870 PMCID: PMC3591558 PMID: 23493852

Conflict of interest statement: Conflict of Interest: None declared

54. World J Surg. 1997 Oct;21(8):816-20; discussion 820-1. doi: 10.1007/s002689900312.

Patterns of injury in victims of urban free-falls.

Velmahos GC(1), Demetriades D, Theodorou D, Cornwell EE 3rd, Belzberg H, Asensio J, Murray J, Berne TV.

Author information: (1)Department of Surgery, University of Southern California, Los Angeles, USA.

The objective of this study was to identify the patterns of injury in urban free-fall victims so as to establish guidelines of management. This prospective study at an academic level I trauma center included 187 consecutive patients who presented to our trauma center during a 9-month period (September 1994 to June 1995) after a fall from a height of 5 to 70 feet. Only three falls were from heights of more than 40 feet. Of these patients, 116 (65.1%) suffered significant trauma. Fractures were the most common injuries, accounting for 76.2% of all injuries. Spinal fractures were detected in 37 patients and were associated with neurologic deficits in 7. Intraabdominal injuries occurred in 11 patients, requiring operative intervention in 9 of them. Solid organ lacerations prevailed, but small bowel perforation and bladder rupture were present in one case each. A significant retroperitoneal hematoma was detected in only one case and a thoracic aortic rupture in one more. The height of the fall correlated highly with the incidence of intoxication and severity of injury, the need for operation, the length of hospitalization, and mortality. Most urban free-falls occur from moderate heights. The spinal column is frequently injured and therefore should be thoroughly assessed clinically and radiographically in all fall victims. Intraabdominal organ injuries are much more common than retroperitoneal ones. Thus the abdominal cavity should be the primary target of aggressive workup in hemodynamically unstable patients. The height of the fall is a good predictor of injury severity and outcome prognosis.

DOI: 10.1007/s002689900312 PMID: 9327672 [Indexed for MEDLINE]

55. Am J Health Syst Pharm. 1997 Mar 1;54(5):537-40. doi: 10.1093/ajhp/54.5.537.

Pharmacokinetics of aztreonam in critically ill surgical patients.

Cornwell EE 3rd(1), Belzberg H, Berne TV, Gill MA, Theodorou D, Kern JW, Yu W, Asensio J, Demetriades D.

Author information: (1)School of Medicine, University of Southern California (USC), USA.

The pharmacokinetics of aztreonam in critically ill surgical patients with serious gram-negative infections were studied. Blood samples were taken before and at 30 minutes, 2.5 hours, and 5 hours after a dose of aztreonam 2 g i.v. every six hours. All patients had received at least two aztreonam doses before the dosage interval being studied. Aztreonam concentrations were measured by high-performance liquid chromatography. Aztreonam’s pharmacokinetics, the severity of illness, and patient outcomes were examined. A total of 28 patients with 111 serum aztreonam concentrations were included in the analysis. The patients were young (mean age, 35 years) and predominantly male. The mean APACHE II score was 19.3, and 22 patients had sepsis. Four patients died. The mean volume of distribution (V) of 0.35 L/ kg was nearly twice the previously reported steady-state value for healthy volunteers (0.18 L/kg) and was highly variable. A slightly higher than normal mean V, 0.22 L/ kg, was seen in a subset of six patients whose infection occurred earlier in their intensive care and who had lower APACHE II scores. While with some antibiotics the elevated V would imply difficulty in achieving therapeutic drug levels, 99 (89%) of the 111 concentrations were at or above the in vitro susceptibility breakpoint of 8 micrograms/mL. Despite observations of markedly increased and highly variable V in critically ill surgical patients, a standard dosage of aztreonam was usually sufficient to maintain adequate serum drug levels.

DOI: 10.1093/ajhp/54.5.537 PMID: 9066861 [Indexed for MEDLINE]

56. J Trauma. 1996 May;40(5):758-60. doi: 10.1097/00005373-199605000-00012.

Transcervical gunshot injuries: mandatory operation is not necessary.

Demetriades D(1), Theodorou D, Cornwell E, Asensio J, Belzberg H, Velmahos G, Murray J, Berne TV.

Author information: (1)Division of Trauma, Los Angeles County/University of Southern California Medical Center, 90033, USA.

BACKGROUND: It has been suggested that all transcervical gunshot wounds should be explored surgically because of the high incidence of injuries to vital structures. The present prospective study investigated the clinical presentation, the role of various diagnostic investigations, and the need for surgery in patients with transcervical gunshot injuries. METHODS: Ninety-seven patients sustained gunshot injuries to the neck and 33 of them (34%) were transcervical. All victims were assessed clinically according to a written protocol and subsequently were evaluated angiographically, and, in the appropriate case, by means of endoscopy and esophagography. RESULTS: Overall, 24 (73%) of the 33 patients with transcervical gunshot wounds had injuries to cervical structures. Vascular injuries were found in 48%, spinal cord injuries in 24%, and aerodigestive tract injuries in 6% of patients with transcervical injuries. In the 64 patients without midline crossing, the incidence of cervical structure injuries was 31%. Despite the high incidence of injuries to cervical structures in transcervical wounds, only 21% of the patients had a therapeutic operation. The overall mortality was 3%. There were no in-hospital deaths or local complications in the nonoperatively managed group. CONCLUSIONS: The results of the present study do not support the current recommendations of mandatory operation for all transcervical gunshot wounds. A careful clinical examination combined with the appropriate diagnostic investigations should determine the treatment modality. About 80% of these patients can safely be managed nonoperatively.

DOI: 10.1097/00005373-199605000-00012 PMID: 8614075 [Indexed for MEDLINE]

57. Am J Infect Control. 2010 Oct;38(8):631-5. doi: 10.1016/j.ajic.2010.01.009. Epub 2010 May 14.

Predictors of mortality of Acinetobacter baumannii infections: A 2-year prospective study in a Greek surgical intensive care unit.

Katsaragakis S(1), Markogiannakis H, Samara E, Pachylaki N, Theodoraki EM, Xanthaki A, Toutouza M, Toutouzas KG, Theodorou D.

Author information: (1)Surgical Intensive Care Unit, First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece.

BACKGROUND: Nosocomial infections are a frequent and continuously increasing problem worldwide, have a rapidly increasing multidrug resistance to antibiotics, and are associated with significant morbidity and mortality. OBJECTIVE: Our objectives were to evaluate Acinetobacter baumannii infection incidence in our surgical intensive care unit (SICU), the clinical features and outcome of these patients, and, particularly, to investigate predictors of A baumannii infection-related mortality. METHODS: Ours was a prospective study of all patients with ICU-acquired A baumannii infection from January 1, 2006, to December 31, 2007. RESULTS: Among 680 patients, 60 (8.8%) sustained A baumannii infection. Mean age was 68.4 ± 6.2 years, Acute Physiology and Chronic Health Evaluation (APACHE) II score on SICU admission 20.6 ± 8.1 and Sequential Organ Failure Assessment (SOFA) score on infection day 9.5 ± 4.2 (women: 50%). Multidrug resistance, morbidity, and mortality were 45%, 65%, and 46.6% (n = 28), respectively. In multivariate analysis, age (P = .03; odds ratio [OR], 1.13; 95% confidence interval [CI]: 1.018-1.259), acute renal failure (P = .001; OR, 17.9; 95% CI: 6.628-75.565), and thrombocytopenia (P = .03; OR, 26.4; 95% CI: 1.234-56.926) complicating the infection and subsequent Enterococcus faecium bacteremia (P = .01; OR, 3.5; 95% CI: 1.84-6.95) were mortality predictors. CONCLUSION: A baumannii infections are frequent and associated with high drug multiresistance, morbidity, and mortality. Age, renal failure, thrombocytopenia, and subsequent E faecium bacteremia were predictors of A baumannii infection-associated mortality.

DOI: 10.1016/j.ajic.2010.01.009 PMID: 20471716 [Indexed for MEDLINE]

58. Hellenic J Cardiol. 2009 May-Jun;50(3):185-92.

Prophylactic preoperative levosimendan administration in heart failure patients undergoing elective non-cardiac surgery: a preliminary report.

Katsaragakis S(1), Kapralou A, Drimousis P, Markogiannakis H, Larentzakis A, Kofinas G, Misthos P, Filis K, Theodorou D.

Author information: (1)Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Greece.

INTRODUCTION: Preoperative optimization of cardiac failure (CF) patients undergoing non-cardiac surgery is of utmost importance. Levosimendan is a promising adjunct in our therapeutic repertoire for the treatment of CF; however, it has not been evaluated in CF patients undergoing non-cardiac surgery. Our objective was to evaluate the safety and efficacy of prophylactic preoperative levosimendan administration in these patients. METHODS: CF patients with ejection fraction <35% undergoing elective non-cardiac (abdominal) surgery during a 6-month-period were included in this prospective study. All patients, admitted to the Surgical Intensive Care Unit (SICU) one day preoperatively for levosimendan administration, received a bolus infusion (2.4 Ig/kg) for 10 min followed by a 24-hour continuous infusion (0.1 Ig/kg/min) at the end of which they were operated. Patients were under continuous hemodynamic monitoring in the SICU during levosimendan infusion and for 24 h post-infusion. Hemodynamic parameters, including heart rate, arterial pressure and pulmonary artery catheter data, were recorded before treatment, 10 min after drug initiation, and at 3-hour intervals to 24 h post-infusion. Echocardiography was performed before infusion and on the 7th post-infusion day. RESULTS: Nine patients were enrolled. Cardiac index (0-48 h, 95% CI: -2.790-0.432, p<0.001) and stroke volume index (0-48 h, 95% CI: -32.53-0.91, p=0.01) increased significantly at 24 h after drug initiation and remained increased for 24 h post-infusion. Systemic vascular resistance index decreased at 10 min and remained reduced during the whole observation period (0-48 h, 95% CI: 875.64-2378.14, p<0.001). Ejection fraction was significantly increased on the 7th post-infusion day (32.65 +/- 7.32 vs. 20.89 +/- 6.24, p<0.05). No adverse reactions, complications or deaths occurred during 30 days’ follow up. CONCLUSION: Prophylactic preoperative levosimendan treatment may be safe and efficient for the perioperative optimization of heart failure patients undergoing non-cardiac surgery.

PMID: 19465359 [Indexed for MEDLINE]

59. Am J Surg. 2007 Jun;193(6):693-6. doi: 10.1016/j.amjsurg.2006.06.049.

The use of a harmonic scalpel in thyroid surgery: report of a 3-year experience.

Koutsoumanis K(1), Koutras AS, Drimousis PG, Stamou KM, Theodorou D, Katsaragakis S, Bramis J.

Author information: (1)Department of Endocrine Surgery, First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocratio Hospital, Athens, Greece.

BACKGROUND: Hemostasis in thyroid surgery is of utmost importance for a successful surgery and an uneventful postoperative course. The present article reports a single surgeon’s 3-year experience in the use of the harmonic scalpel. The device was developed in the early 1990s and offered adequate and safe hemostasis for vessels up to 3 mm in width. METHODS: This was a prospective observational study. Data sheets from all patients who had surgery by a single endocrine surgeon in the period from 1999 to 2004 were evaluated. Patients were divided into 3 groups based on the surgical technique used: group I comprised the conventional knot-and-tie technique, group II comprised the ligation of all but the superior thyroid vessels with a scalpel, and group III comprised patients in whom the device was used exclusively. The groups were compared in regard to surgical time, cost, and complication rate. RESULTS: A total of 272 patients were included in the study: 107 patients were included in group I, 77 in group II, and 88 group III. The surgical time of group I differed significantly compared with groups II and III (P < .0001 in both cases). Surgical times between groups II and III did not differ significantly (P = .701). CONCLUSIONS: The use of the harmonic scalpel reduces surgical time, but it increases the cost of the surgery. It is our belief that by including in the absolute cost the time saved and the reduction in human resources needed, the use of the scalpel would prove to be economic.

DOI: 10.1016/j.amjsurg.2006.06.049 PMID: 17512278 [Indexed for MEDLINE]

60. J Oral Maxillofac Surg. 2007 Apr;65(4):635-9. doi: 10.1016/j.joms.2006.06.287.

Descending necrotizing anterior mediastinitis: analysis of survival and surgical treatment modalities.

Misthos P(1), Katsaragakis S, Kakaris S, Theodorou D, Skottis I.

Author information: (1)First Propaedeutic Surgical Department, University of Athens Medical School, Athens, Greece. panmisthos@yahoo.gr

PURPOSE: Descending necrotizing anterior mediastinitis (DNAM) is a severe infectious disease with a very high mortality rate. The aim of this study was to define the impact of several clinical factors on survival. PATIENTS AND METHODS: Between 1985 and 2002, 27 patients were managed for DNAM, 11 with combined transthoracic mediastinal and cervical drainage (group A) and 16 with a less aggressive surgical approach, such as cervical drainage and transcervical mediastinal drainage (group B). The records of all patients were statistically analyzed for the impact of several clinical factors on survival. RESULTS: Although patients in group A were admitted to the hospital faster, treated with antibiotics as outpatients earlier, and operated on much sooner after hospital admission compared with the patients in group B, multivariate analysis revealed that early combined transthoracic mediastinal and cervical debridement and drainage was the only favorable factor for survival in patients DNAM patients (odds ratio = 9.99; 95% confidence interval = 1.02 to 97.49). CONCLUSIONS: Less extensive surgical approaches (ie, thoracic drainage without cervical drainage or combined cervical and subxiphoid thoracic drainage) led to unsatisfactory results and high reoperation rates. In contrast, early, aggressive combined cervical and thoracic drainage proved to be an effective method for managing DNAM.

DOI: 10.1016/j.joms.2006.06.287 PMID: 17368356 [Indexed for MEDLINE]

61. Haemophilia. 2007 Jul;13(4):440-2. doi: 10.1111/j.1365-2516.2007.01465.x.

True radial artery aneurysm in a mild haemophilia A patient.

Filis K, Arhontovassilis F, Theodorou D, Theodossiades G, Manouras A.

DOI: 10.1111/j.1365-2516.2007.01465.x PMID: 17610564 [Indexed for MEDLINE]

62. Int J Vitam Nutr Res. 2007 Mar;77(2):125-9. doi: 10.1024/0300-9831.77.2.125.

High-dose ascorbic acid decreases cholesterolemic factors of an atherogenic diet in guinea pigs.

Filis K(1), Anastassopoulou A, Sigala F, Theodorou D, Manouras A, Leandros E, Sigalas P, Hepp W, Bramis J.

Author information: (1)First Department of Propedeutic Surgery, University of Athens Medical School, Athens, Greece.

BACKGROUND: The study evaluates the effect of a high supplemental dose of ascorbic acid (AA) on plasma concentrations of total cholesterol (TC), triglycerides (TG), total lipids (TL), and lipoprotein fractions high-density, very-low-density-, and low-density lipoprotein (HDL, VLDL, LDL) in guinea pigs fed with atherogenic diet. METHODS: Group I consisted of 5 normally fed guinea pigs plus a low dose of AA (1 mg/100 g/day), group II consisted of 7 guinea pigs fed with food enriched with 2% cholesterol plus a low dose of AA (1 mg/100 g/day), and group III consisted of 7 guinea pigs fed with food enriched with 2% cholesterol plus a high dose of AA (30 mg/100 g/day). Cholesterolemic factors concentrations were determined after nine weeks. RESULTS: Concentrations of TC, TG, TL, LDL, and VLDL were increased in group II compared to group I (p < 0.01 for all differences). Supplementation with a high dose of AA resulted in decreased concentrations of TC (p < 0.01), TG (p < 0.01), TL (p < 0.01), and LDL (p < 0.01) in group III compared to group II. Additionally, concentration of HDL was increased in group III compared to group II (p < 0.01). CONCLUSION: High-dose AA supplementation to an atherogenic diet decreases concentrations of TC, TG, TL, and LDL and increases concentration of HDL compared to low-dose AA.

DOI: 10.1024/0300-9831.77.2.125 PMID: 17896585 [Indexed for MEDLINE]

63. J Trauma. 2005 Oct;59(4):905-11. doi: 10.1097/01.ta.0000188086.02488.b1.

Esophageal dysfunction in cervical spinal cord injury: a potentially important mechanism of aspiration.

Neville AL(1), Crookes P, Velmahos GC, Vlahos A, Theodorou D, Lucas CE.

Author information: (1)Department of Surgery, Los Angeles County and University of Southern California Medical Center, 90033, USA. angelane@usc.edu

BACKGROUND: Respiratory complications are a major cause of morbidity and mortality in patients with cervical spinal cord injury (CSCI). We hypothesized that patients with CSCI had esophageal dysfunction, predisposing them to aspiration. The purpose of this study was to characterize esophageal function in these patients. METHODS: CSCI and similarly injured control (spinal cord injury below T1) subjects were prospectively enrolled from two trauma centers. All underwent esophageal manometry to measure lower (LES) and upper esophageal sphincter (UES) pressures. A subset of patients had detailed manometry and 24-hour pH studies performed to evaluate dynamic esophageal function. RESULTS: Eighteen CSCI and five control subjects were enrolled. The groups were similar with regards to age, sex, injury mechanism, Injury Severity Score, and hospital stay. Resting LES and UES pressures were similar in CSCI and control patients and did not differ from established norms. Five CSCI and two control patients underwent detailed manometric assessment. Defective UES relaxation was observed in all CSCI patients but not controls. CSCI patients had increased UES relaxation pressures (18.4 +/- 5.3 versus 3.9 +/- 0.7 mm Hg; p = 0.01) and UES bolus pressures (23.8 +/- 2.2 versus 10.2 +/- 6.9 mm Hg; p = 0.006) compared with controls. Esophageal body and LES function were normal. Two of five CSCI patients had abnormal 24-hour pH studies. CONCLUSION: Patients with CSCI demonstrate significantly disturbed dynamic function of the pharynx and UES while resting parameters remain normal. Because adequate UES relaxation is critical to the clearance of secretions and coordination of swallowing, this is an important potential mechanism of aspiration in patients with CSCI.

DOI: 10.1097/01.ta.0000188086.02488.b1 PMID: 16374280 [Indexed for MEDLINE]

64. World J Surg. 2008 Jun;32(6):1194-202. doi: 10.1007/s00268-008-9571-3.

Acinetobacter baumannii infections in a surgical intensive care unit: predictors of multi-drug resistance.

Katsaragakis S(1), Markogiannakis H, Toutouzas KG, Drimousis P, Larentzakis A, Theodoraki EM, Theodorou D.

Author information: (1)Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens 11527, Greece.

OBJECTIVES: This study was designed to evaluate Acinetobacter baumannii infections incidence in our Surgical Intensive Care Unit, clinical features and outcome of these patients, and multi-resistance incidence to identify predictors of such a resistance. METHODS: Prospective study of all patients with ICU-acquired Acinetobacter baumannii infection from June 1, 2003 to May 31, 2005. Patients with multi-resistant infection, susceptible exclusively to colistin, were compared with those sustaining non-multi-drug resistant infection. RESULTS: Among 411 patients, 52 (12.6%) developed Acinetobacter infection. Their mean age was 66.3 +/- 8.4 years and APACHE II 20.4 +/- 7.3 (men: 51.9%). Infection sites were: bloodstream (46.2%), respiratory tract (32.7%), central venous catheter (11.5%), surgical site (7.7%), and urinary tract (1.9%). High multi-resistance (44.2%), morbidity (63.4%), and mortality (44.2%) were identified. Colistin was the most effective antibiotic (100% susceptibility), whereas resistance against all other antibiotics was >60%. Previous septic shock (p = 0.04), previous adult respiratory distress syndrome (ARDS) (p = 0.01), number of previous antibiotics (p = 0.01), previous aminoglycoside use (p = 0.04), and reoperation (p = 0.01) were risk factors for multi-resistance in univariate analysis. Morbidity in the multi-resistant group was significantly higher than the non-multi-resistant group (82.6% vs. 48.2%, p = 0.02). Mortality in the multi-resistant group also was higher; however, this difference did not marginally reach statistical significance (60.8% vs. 31.1%, p = 0.06). Multivariate analysis identified previous septic shock (p = 0.04; odds ratio (OR), 9.83; 95% confidence interval (CI), 1.003-96.29) and reoperation (p = 0.01; OR, 8.45; 95% CI, 1.52-46.85) as independent predictors of multi-resistance. CONCLUSION: Acinetobacter baumannii infections are frequent and associated with high morbidity, mortality, and multi-resistance. Avoidance of unnecessary antibiotics is a high priority, and specific attention should be paid to patients with previous ARDS and, particularly, previous septic shock and reoperation. When such risk factors are identified, colistin may be the only appropriate treatment.

DOI: 10.1007/s00268-008-9571-3 PMID: 18408967 [Indexed for MEDLINE]

65. J Med Case Rep. 2009 Nov 14;3:125. doi: 10.1186/1752-1947-3-125.

Anastomotic leak management after a low anterior resection leading to recurrent abdominal compartment syndrome: a case report and review of the literature.

Toutouzas K(1), Kleidi ES, Drimousis PG, Balla M, Papanikolaou MN, Larentzakis A, Theodorou D, Katsaragakis S.

Author information: (1)1st Department of Propaedeutic Surgery, Surgical Intensive Care Unit, University of Athens, Athens Medical School, Hippocration Hospital, Athens, Greece.

INTRODUCTION: Low anterior resection is usually the procedure of choice for rectal cancer, but a series of complications often accompany this procedure. This case report describes successful management of an intricate anastomotic leak after a low anterior resection. CASE PRESENTATION: A 66-year-old Caucasian man was admitted to our hospital and diagnosed with a low rectal adenocarcinoma. He underwent a low anterior resection but subsequently developed fecal peritonitis due to an anastomotic leak. He was operated on again but developed abdominal compartment syndrome, multi-organ failure and sepsis. He was aggressively treated in the intensive care unit and in the operating room. Overall, the patient underwent four laparotomies and stayed in the intensive care unit for 75 days. He was discharged after 3 months of hospitalization. CONCLUSION: Abdominal compartment syndrome may present as a devastating complication of damage control laparotomy. Prompt recognition and goal-directed management are the cornerstones of treatment.

DOI: 10.1186/1752-1947-3-125 PMCID: PMC2803799 PMID: 20062765

66. Methods Find Exp Clin Pharmacol. 2006 Jun;28(5):307-13. doi: 10.1358/mf.2006.28.5.990203.

Refractory septic shock: efficacy and safety of very high doses of norepinephrine.

Katsaragakis S(1), Kapralou A, Theodorou D, Markogiannakis H, Larentzakis A, Stamou KM, Drimousis P, Bramis I.

Author information: (1)Surgical Intensive Care Unit, First Department of Propaedeutic Surgery, Athens Medical School, University of Athens, Hippocratio Hospital, Athens, Greece.

The aim of this study was to evaluate the safety, efficacy, and effects of administration of very high doses of norepinephrine (> 4 microg kg(-1) min(-1)) in catecholamine-resistant septic shock. We reviewed the charts of all patients with nonresponding to commonly used norepinephrine doses (< or = 4 microg kg(-1) min(-1)) septic shock from January 1999 to December 2002 in our Surgical Intensive Care Unit. All patients were treated with high norepinephrine doses (> 4 microg kg(-1) min(-1)), after initial resuscitation, so as to achieve a mean arterial pressure higher than or equal to 65 mmHg. During this 4-year period, 12 consecutive patients with catecholamine-resistant septic shock were included in our study. When compared with the values obtained prior to the administration of very high norepinephrine doses, the values of mean arterial pressure (p = 0.003) and systemic vascular resistance (p = 0.002) significantly increased after the administration of such doses, and additionally, lactate concentrations (p = 0.003) decreased. In contrast, no significant changes were observed regarding mean central venous pressure, pulmonary capillary wedge pressure, and pulmonary arterial pressure. Administration of high norepinephrine doses in our patients resulted in a survival rate of 33.4%. Management of catecholamine-resistant septic shock patients poses a challenging problem. Administration of very high norepinephrine doses is safe and effective and may improve survival of these patients with otherwise extremely high mortality rates.

DOI: 10.1358/mf.2006.28.5.990203 PMID: 16845448 [Indexed for MEDLINE]

67. Int J Infect Dis. 2009 Mar;13(2):145-53. doi: 10.1016/j.ijid.2008.05.1227. Epub 2008 Sep 5.

Infections in a surgical intensive care unit of a university hospital in Greece.

Markogiannakis H(1), Pachylaki N, Samara E, Kalderi M, Minettou M, Toutouza M, Toutouzas KG, Theodorou D, Katsaragakis S.

Author information: (1)Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Vas. Sofias 114 av., 11527, Athens, Greece. markogiannakis@yahoo.com

OBJECTIVES: We aimed to evaluate the clinical and microbiological characteristics of the patients who developed an infection in our surgical intensive care unit (SICU). METHODS: This was a prospective study of all patients who sustained an ICU-acquired infection from 2002 to 2004. RESULTS: Among 683 consecutive SICU patients, 123 (18.0%) developed 241 infections (48.3 infections per 1000 patient-days). The mean age of patients was 66.7+/-3.8 years, the mean APACHE II score (acute physiology and chronic health evaluation) on SICU admission was 18.2+/-2.4, and the mean SOFA score (sepsis-related organ failure assessment) at the onset of infection was 8.8+/-2. Of the study patients, 51.2% were women. Infections were: bloodstream (36.1%), ventilator-associated pneumonia (VAP; 25.3%, 20.3/1000 ventilator-days), surgical site (18.7%), central venous catheter (10.4%, 7.1/1000 central venous catheter-days), and urinary tract infection (9.5%, 4.6/1000 urinary catheter-days). The most frequent microorganisms found were: Acinetobacter baumannii (20.3%), Pseudomonas aeruginosa (15.7%), Candida albicans (13.2%), Enterococcus faecalis (10.4%), Klebsiella pneumoniae (9.2%), Enterococcus faecium (7.9%), and Staphylococcus aureus (6.7%). High resistance to the majority of antibiotics was identified. The complication and mortality rates were 58.5% and 39.0%, respectively. Multivariate analysis identified APACHE II score on admission (odds ratio (OR) 4.63, 95% confidence interval (CI) 2.69-5.26, p=0.01), peritonitis (OR 1.85, 95% CI 1.03-3.25, p=0.03), acute pancreatitis (OR 2.27, 95% CI 1.05-3.75, p=0.02), previous aminoglycoside use (OR 2.84, 95% CI 1.06-5.14, p=0.03), and mechanical ventilation (OR 3.26, 95% CI: 2.43-6.15, p=0.01) as risk factors for infection development. Age (OR 1.16, 95% CI 1.01-1.33, p=0.03), APACHE II score on admission (OR 2.53, 95% CI 1.77-3.41, p=0.02), SOFA score at the onset of infection (OR 2.88, 95% CI 1.85-4.02, p=0.02), and VAP (OR 1.32, 95% CI 1.04-1.85, p=0.03) were associated with mortality. CONCLUSIONS: Infections are an important problem in SICUs due to high incidence, multi-drug resistance, complications, and mortality rate. In our study, APACHE II score on admission, peritonitis, acute pancreatitis, previous aminoglycoside use, and mechanical ventilation were identified as risk factors for infection development, whereas age, APACHE II score on admission, SOFA score at the onset of infection, and VAP were associated with mortality.

DOI: 10.1016/j.ijid.2008.05.1227 PMID: 18775663 [Indexed for MEDLINE]

68. World J Gastroenterol. 2007 Apr 21;13(15):2258-60. doi: 10.3748/wjg.v13.i15.2258.

Persistent omphalomesenteric duct causing small bowel obstruction in an adult.

Markogiannakis H(1), Theodorou D, Toutouzas KG, Drimousis P, Panoussopoulos SG, Katsaragakis S.

Author information: (1)Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Kerasoudos 54 Street, 15771 Zografou, Athens, Greece. hmarkogiannakis@mycosmos.gr

An extremely rare case of persistent omphalomesenteric duct causing small bowel obstruction is presented. A 20-year-old female patient without medical history presented with colicky abdominal pain, vomiting, absence of passage of gas and feces, and abdominal distension of 24 h duration. Physical examination and blood tests were normal. Abdominal X-ray showed small bowel obstruction. Computed tomography of the abdomen demonstrated dilated small bowel and a band originating from the umbilicus and continuing between the small bowel loops; an omphalomesenteric duct remnant was suspected. In exploratory laparotomy, persistent omphalomesenteric duct causing small bowel obstruction was identified and resected. The patient had an uneventful recovery and was discharged on the 5(th) postoperative day. Although persistent omphalomesenteric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.

DOI: 10.3748/wjg.v13.i15.2258 PMCID: PMC4146858 PMID: 17465515 [Indexed for MEDLINE]

69. Hellenic J Cardiol. 2007 May-Jun;48(3):134-42.

Management of early and late detected vascular complications following femoral arterial puncture for cardiac catheterization.

Filis K(1), Arhontovasilis F, Theodorou D, Albanopoulos K, Lagoudianakis E, Manouras A, Vavuranakis M, Vlachopoulos C, Toutouzas K, Tsiamis E, Androulakis A, Kallikazaros I, Giannopoulos A, Bramis I, Stefanadis C.

Author information: (1)Division of Vascular Surgery, First Department of Propedeutic Surgery, University of Athens Medical School, Athens, Greece. kfilis@hotmail.com

INTRODUCTION: latrogenic vascular trauma is more frequent today as a result of the increase in diagnostic and therapeutic femoral catheterizations. Management of related complications is elective or urgent and sometimes needs complex vascular reconstruction. The present study evaluated when and whether conservative, urgent surgical, or elective surgical treatment is appropriate. METHODS: A retrospective analysis was made of 45 consecutive iatrogenic vascular trauma patients, among 10,450 cardiac diagnostic or therapeutic catheterizations. Patients’ demographics, type of catheterization, time from catheterization to initial diagnosis, the type of complication (thrombosis, infection, bleeding, pseudoaneurysm, etc.), time from presentation of the complication to definite treatment, diagnostic imaging and decision making, the surgical or conservative management, the length of stay and the clinical outcome were determined and analyzed. RESULTS: We identified and treated 30 early and 15 late (after patient’s discharge) arterial complications: 18 pseudoaneurysms, 6 bleedings, 9 hematomas, 5 deep vein thromboses, 3 arteriovenous fistulas, 2 arterial embolisms and 2 arterial thromboses. Eight patients underwent emergency surgical repair, three elective surgical repair and 31 were managed conservatively. Decision making was based only on clinical evaluation in 12 patients, whereas vascular ultrasound was the most frequent diagnostic imaging modality in the remainder. A total of 10 (22.2%) minor secondary complications were identified after the initial management with no limb loss and zero mortality. CONCLUSIONS: Close clinical observation and conservative management of vascular trauma complications resulted in a low incidence of the necessity for surgical repair (25% of cases). Bleeding and acute leg ischemia were the most frequent indication for emergency surgical treatment, whereas the majority of pseudoaneurysms, fistulas and vein thrombosis were successfully treated conservatively. Late vascular complications do occur and add an important morbidity factor to early catheterization complications.

PMID: 17629176 [Indexed for MEDLINE]

70. Eur J Cardiothorac Surg. 2005 Mar;27(3):379-82; discussion 382-3. doi: 10.1016/j.ejcts.2004.12.023. Epub 2005 Jan 23.

Postresectional pulmonary oxidative stress in lung cancer patients. The role of one-lung ventilation.

Misthos P(1), Katsaragakis S, Milingos N, Kakaris S, Sepsas E, Athanassiadi K, Theodorou D, Skottis I.

Author information: (1)First Thoracic Surgical Department, SOTIRIA General Hospital for Chest Diseases, 7 P. Dimitrakopoulou Street, 11141 Athens, Greece. pamnisthos@yahoo.gr

OBJECTIVE: The authors conducted a prospective analysis in order to investigate through lipid peroxidation metabolites the generation of oxygen free radicals after one-lung ventilation (OLV). METHODS: From 2001 to 2003, 212 patients were prospectively studied for lung reexpansion/reperfusion injury. They were classified in six groups. Group A, non-OLV lobectomy group; B, OLV pneumonectomy group; C-E, OLV lobectomy of 60, 90, and 120 min duration, respectively; F, normal subjects as baseline group. Preoperative, intraoperative and postoperative strict blood sampling protocol was followed. Malondialdehyde (MDA) plasma levels were measured. The recorded values were analyzed and statistically compared between groups and within each one. RESULTS: Comparison of groups C-E (OLV) to all other documented significant (P<0.001) increase of MDA levels during lung reexpansion and for the following 12h. The magnitude of oxidative stress was related to OLV duration (group E>D>C, all P<0.001). The removal of cancer-associated parenchyma led to MDA level decrease postoperatively (P<0.001) especially after pneumonectomy (A vs. B, P<0.001). CONCLUSIONS: (1) Lung reexpansion provoked severe oxidative stress. (2) The degree of the amount of generated oxygen free radicals was associated to the duration of OLV. (3) Patients with lung cancer had a higher production of oxygen free radicals than normal population. (4)Tumor resection removes a large oxidative burden from the organism. (5) Mechanical ventilation and surgical trauma are weak free radical generators. (6) Manipulated lung tissue is also a source of oxygen free radicals, not only intraoperatively but also for several hours later.

DOI: 10.1016/j.ejcts.2004.12.023 PMID: 15740942 [Indexed for MEDLINE]

71. J Med Case Rep. 2008 Jan 22;2:15. doi: 10.1186/1752-1947-2-15.

Small cell carcinoma arising in Barrett’s esophagus: a case report and review of the literature.

Markogiannakis H(1), Theodorou D, Toutouzas KG, Larentzakis A, Pattas M, Bousiotou A, Papacostas P, Filis K, Katsaragakis S.

Author information: (1)Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece. markogiannakis@easy.com

INTRODUCTION: Gastrointestinal tract small cell carcinoma is an infrequent and aggressive neoplasm that represents 0.1-1% of gastrointestinal malignancies. Very few cases of small cell esophageal carcinoma arising in Barrett’s esophagus have been reported in the literature. An extremely rare case of primary small cell carcinoma of the distal third of the esophagus arising from dysplastic Barrett’s esophagus is herein presented. CASE PRESENTATION: A 62-year-old man with gastroesophageal reflux history presented with epigastric pain, epigastric fullness, dysphagia, anorexia, and weight loss. Esophagogastroscopy revealed an ulceroproliferative, intraluminar mass in the distal esophagus obstructing the esophageal lumen. Biopsy showed small cell esophageal carcinoma. Contrast-enhanced chest and abdominal computed tomography demonstrated a large tumor of the distal third of the esophagus without any lymphadenopathy or distant metastasis. Preoperative chemotherapy with cisplatine and etoposide for 3 months resulted in a significant reduction of the tumor. After en block esophagectomy with two field lymph node dissection, proximal gastrectomy, and cervical esophagogastric anastomosis, the patient was discharged on the 14th postoperative day. Histopathology revealed a primary small cell carcinoma of the distal third of the esophagus arising from dysplastic Barrett’s esophagus. The patient received another 3 month course of postoperative chemotherapy with the same agents and remained free of disease at 12 month review. CONCLUSION: Although small cell esophageal carcinoma is rare and its association with dysplastic Barrett’s esophagus is extremely infrequent, the high carcinogenic risk of Barrett’s epithelium should be kept in mind. Prognosis is quite unfavorable; a better prognosis might be possible with early diagnosis and treatment strategies incorporating chemotherapy along with oncological radical surgery and/or radiotherapy as part of a multimodality approach. Since treatment protocols are not well established due to the rarity of the neoplasm, multi-institutional studies are needed to obtain sufficiently large populations for investigation and optimization of therapy of the disease.

DOI: 10.1186/1752-1947-2-15 PMCID: PMC2263060 PMID: 18211708

72. Am J Surg. 2004 Jan;187(1):114-9. doi: 10.1016/j.amjsurg.2002.12.005.

Cognitive task analysis for teaching technical skills in an inanimate surgical skills laboratory.

Velmahos GC(1), Toutouzas KG, Sillin LF, Chan L, Clark RE, Theodorou D, Maupin F.

Author information: (1)Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. velmahos@usc.edu

BACKGROUND: The teaching of surgical skills is based mostly on the traditional “see one, do one, teach one” resident-to-resident method. Surgical skills laboratories provide a new environment for teaching skills but their effectiveness has not been adequately tested. Cognitive task analysis is an innovative method to teach skills, used successfully in nonmedical fields. The objective of this study is to evaluate the effectiveness of a 3-hour surgical skills laboratory course on central venous catheterization (CVC), taught by the principles of cognitive task analysis to surgical interns. METHODS: Upon arrival to the Department of Surgery, 26 new interns were randomized to either receive a surgical skills laboratory course on CVC (“course” group, n = 12) or not (“traditional” group, n = 14). The course consisted mostly of hands-on training on inanimate CVC models. All interns took a 15-item multiple-choice question test on CVC at the beginning of the study. Within two and a half months all interns performed CVC on critically ill patients. The outcome measures were cognitive knowledge and technical-skill competence on CVC. These outcomes were assessed by a 14-item checklist evaluating the interns while performing CVC on a patient and by the 15-item multiple-choice-question test, which was repeated at that time. RESULTS: There were no differences between the two groups in the background characteristics of the interns or the patients having CVC. The scores at the initial multiple-choice test were similar (course: 7.33 +/- 1.07, traditional: 8 +/- 2.15, P = 0.944). However, the course interns scored significantly higher in the repeat test compared with the traditional interns (11 +/- 1.86 versus 8.64 +/- 1.82, P = 0.03). Also, the course interns achieved a higher score on the 14-item checklist (12.6 +/- 1.1 versus 7.5 +/- 2.2, P <0.001). They required fewer attempts to find the vein (3.3 +/- 2.2 versus 6.4 +/- 4.2, P = 0.046) and showed a trend toward less time to complete the procedure (15.4 +/- 9.5 versus 20.6 +/- 9.1 minutes, P = 0.149). CONCLUSIONS: A surgical skills laboratory course on CVC, taught by the principles of cognitive task analysis and using inanimate models, improves the knowledge and technical skills of new surgical interns on this task.

DOI: 10.1016/j.amjsurg.2002.12.005 PMID: 14706600 [Indexed for MEDLINE]

73. Acta Haematol. 2008;120(3):190-1. doi: 10.1159/000187647. Epub 2009 Jan 5.

Heparin-induced thrombocytopenia and phlegmasia cerulea dolens of the upper limb successfully treated with fondaparinux.

Filis K(1), Lagoudianakis EE, Pappas A, Kotzadimitriou K, Genetzakis M, Sigala F, Theodorou D, Manouras A.

Author information: (1)Vascular Unit, First Department of Propaedeutic Surgery, Hippocrateion Hospital, Athens Medical School, Athens, Greece.

DOI: 10.1159/000187647 PMID: 19129690 [Indexed for MEDLINE]

74. Obes Surg. 2010 Mar;20(3):276-82. doi: 10.1007/s11695-009-9918-3. Epub 2009 Jul 28.

Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year.

Menenakos E(1), Stamou KM, Albanopoulos K, Papailiou J, Theodorou D, Leandros E.

Author information: (1)Department of Endoscopic Surgery, Hippocratio Hospital, 20-22, Alkimahou Street, Athens, 11634, Greece.

BACKGROUND: The aim of the study is to look at laparoscopic sleeve gastrectomy as a procedure with intent to cure morbid obesity. Secondary endpoints are related to the safety profile of the procedure. METHODS: This is a prospective clinical study conducted in a single university surgical clinic. RESULTS: Two hundred sixty-one patients (2.5:1 female to male ratio, median age of 37 years) underwent sleeve gastrectomy. Median preoperative body mass index (BMI) was 45.2 kg/m(2). Mortality and morbidity rates were 0.7% and 8.4%, respectively. Risk factors for postoperative complications were history of diabetes mellitus under medical treatment (OR, 4.0; p = 0.014) and prior bariatric operation on the same patient (OR, 5.7, p = 0.034). Median follow-up was 12 months (range 1-29 months). A BMI > 50 kg/m(2) is connected with greater weight loss. Analysis of the percentage of excess weight loss (%EWL) during follow-up at specific time intervals showed a rapid increase for the first 12 months followed by a more gradual rise thereafter. The median %EWL for the first year of follow-up was 65.7 (range 33.8-102.3). The median BMI for the patients that had completed at least 1 year of follow-up was 30.5 kg/m(2) (range 21.2-42.7). The overall success rate after the first year was 74.3% when accounted for %EWL > 50 and 81.7% for BMI < 35 kg/m(2). CONCLUSIONS: The actual long-term efficacy of the procedure remains to be confirmed. Morbidity rates may prove higher than expected especially during the learning curve.

DOI: 10.1007/s11695-009-9918-3 PMID: 19636644 [Indexed for MEDLINE]

75. J Trauma. 1996 May;40(5):761-3. doi: 10.1097/00005373-199605000-00013.

Mortality and prognostic factors in penetrating injuries of the aorta.

Demetriades D(1), Theodorou D, Murray J, Asensio JA, Cornwell EE 3rd, Velmahos G, Belzberg H, Berne TV.

Author information: (1)Division of Trauma, Los Angeles County and University of Southern California Medical Center 90033, USA.

PURPOSE: This study was designed to investigate the epidemiology and prognostic factors determining survival in penetrating injuries of the aorta. PATIENTS AND METHODS: This was a retrospective analysis of all patients with penetrating aortic injuries, admitted to a large, level I trauma center. The following factors were analyzed for their role in determining survival: mechanism of injury, anatomical site of the aortic injury, initial blood pressure on admission, need for emergency room thoracotomy, and the introduction of a dedicated trauma program with an attending surgeon in-house. RESULTS: There were 93 patients with penetrating aortic injuries over a 5-year period. The abdominal aorta was injured in 67 patients (72%) and the thoracic aorta in 26 (28%). Most of the victims (82.5%) were admitted in shock and 41% had an unrecordable blood pressure on admission. Victims with injury to the thoracic aorta were more likely to have an unrecordable blood pressure on admission than patients with abdominal aortic injuries (73% vs 28.4%), and more likely to require an emergency room thoracotomy (76.9% vs 20.9%). Thirty-four patients (36.6%) required an emergency room thoracotomy and there were no survivors. The overall mortality was 80.6% (87.5% for gunshot injuries, 64.7 % for knife injuries). Patients with abdominal aortic injuries were three times more likely to survive than those with thoracic aortic injuries (23.9% vs 7.7%). The introduction of a dedicated trauma program, which resulted in significant reduction of mortality in other types of severe trauma, had no effect on the outcome in aortic injuries. CONCLUSIONS: Penetrating aortic injuries still have a very high mortality rate with no improvement in survival despite improved trauma services. Injury to the thoracic aorta, gunshot wounds, unrecordable blood pressure on admission, and the need for emergency room thoracotomy, are important predictors of high mortality.

DOI: 10.1097/00005373-199605000-00013 PMID: 8614076 [Indexed for MEDLINE]

76. World J Gastrointest Surg. 2011 Apr 27;3(4):56-8. doi: 10.4240/wjgs.v3.i4.56.

Transanal polypectomy using single incision laparoscopic instruments.

Dardamanis D(1), Theodorou D, Theodoropoulos G, Larentzakis A, Natoudi M, Doulami G, Zoumpouli C, Markogiannakis H, Katsaragakis S, Zografos GC.

Author information: (1)Dimitrios Dardamanis, Dimitrios Theodorou, George Theodoropoulos, Andreas Larentzakis, Maria Natoudi, Georgia Doulami, Haridimos Markogiannakis, Stylianos Katsaragakis, George C Zografos, First Department of Propaedeutic Surgery, Athens Medical School, University of Athens, Hippocration Hospital, Vasilissis Sofias 114 avenue, Athens 11527, Greece.

Transanal excision of rectal polyps with laparoscopic instrumentation and a single incision laparoscopic port is a novel technique that uses technology originally developed for abdominal procedures from the natural orifice of the rectum. Transanal endoscopic microsurgery (TEM) is a well established surgical approach for certain benign or early malignant lesions of the rectum, under specific indications. Our technique is a hybrid technique of transanal surgery, a reasonable method for polyp resection without the need of the sophisticated and expensive instrumentation of TEM which can be applied whenever endoscopic or conventional transanal surgical removal is not feasible.

DOI: 10.4240/wjgs.v3.i4.56 PMCID: PMC3083502 PMID: 21528096

77. Surgery. 2014 Mar;155(3):582. doi: 10.1016/j.surg.2013.10.023. Epub 2013 Oct 22.

Comment on “peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy produce a similar short-term anatomic and functional effect”.

Doulami G(1), Theodorou D(2).

Author information: (1)”Hippokration” General Hospital of Athens, 1st Propaedeutic Surgical Clinic, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: tzinagb@yahoo.gr. (2)”Hippokration” General Hospital of Athens, 1st Propaedeutic Surgical Clinic, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece.

Comment on Surgery. 2013 Oct;154(4):785-91; discussion 791-3.

DOI: 10.1016/j.surg.2013.10.023 PMID: 24462076 [Indexed for MEDLINE]

78. World J Gastroenterol. 2007 Feb 28;13(8):1289-91. doi: 10.3748/wjg.v13.i8.1289.

Capsule endoscopy retention as a helpful tool in the management of a young patient with suspected small-bowel disease.

Kalantzis C(1), Apostolopoulos P, Mavrogiannis P, Theodorou D, Papacharalampous X, Bramis I, Kalantzis N.

Author information: (1)Gastroenterology Department, NIMTS Hospital, 10-12 Monis Petraki str, Athens, Greece.

Capsule endoscopy is an easy and painless procedure permitting visualization of the entire small-bowel during its normal peristalsis. However, important problems exist concerning capsule retention in patients at risk of small bowel obstruction. The present report describes a young patient who had recurrent episodes of overt gastrointestinal bleeding of obscure origin, 18 years after small bowel resection in infancy for ileal atresia. Capsule endoscopy was performed, resulting in capsule retention in the distal small bowel. However, this event contributed to patient management by clearly identifying the site of obstruction and can be used to guide surgical intervention, where an anastomotic ulcer is identified.

DOI: 10.3748/wjg.v13.i8.1289 PMCID: PMC4147012 PMID: 17451218 [Indexed for MEDLINE]

79. J Trauma. 1996 May;40(5):768-74. doi: 10.1097/00005373-199605000-00015.

Radiographic cervical spine evaluation in the alert asymptomatic blunt trauma victim: much ado about nothing.

Velmahos GC(1), Theodorou D, Tatevossian R, Belzberg H, Cornwell EE 3rd, Berne TV, Asensio JA, Demetriades D.

Author information: (1)Department of Surgery, University of Southern California and the Los Angeles County/USC Medical Center 90033-4525, USA.

OBJECTIVE: To evaluate the hypothesis that alert nonintoxicated trauma patients with negative clinical examinations are at no risk of cervical spine injury and do not need any radiographic investigation. DESIGN: Prospective study. SETTING: A university-affiliated teaching county hospital. PATIENTS: Five hundred and forty-nine consecutive alert, oriented, and clinically nonintoxicated blunt trauma victims with no neck symptoms. RESULTS: All patients had negative clinical neck examinations. After radiographic assessment, no cervical spine injuries were identified. Less than half the patients could be evaluated adequately with the three standard initial views (anteroposterior, lateral, and odontoid). All the rest needed more radiographs and/or computed tomographic scans. A total of 2,27 cervical spine radiographs, 78 computed tomographic scans and magnetic resonance imagings were performed. Seventeen patients stayed one day in the hospital for no other reason but radiographic clearance of an asymptomatic neck. The total cost for x-rays and extra hospital days was $242,000. These patients stayed in the collar for an average of 3.3 hours (range, 0.5-72 hours). There was never an injury missed. CONCLUSIONS: Clinical examination alone can reliably assess all blunt trauma patients who are alert, nonintoxicated, and report no neck symptoms. In the absence of any palpation or motion neck tenderness during examination, the patient may be released from cervical spine precautions without any radiographic investigations.

DOI: 10.1097/00005373-199605000-00015 PMID: 8614078 [Indexed for MEDLINE]

80. World J Surg. 1997 Mar-Apr;21(3):247-52; discussion 253. doi: 10.1007/s002689900224.

Complications and nonclosure rates of fasciotomy for trauma and related risk factors.

Velmahos GC(1), Theodorou D, Demetriades D, Chan L, Berne TV, Asensio J, Cornwell EE 3rd, Belzberg H, Stewart BM.

Author information: (1)Department of Surgery, University of Southern California, Los Angeles County/University of Southern California Medical Center, 1200 N. State Street, Room 9900, Los Angeles, California 90033, U.S. A.

The objective of this study was to identify risk factors for the development of complications and unsatisfactory skin closure following fasciotomy for trauma. Risk factors included in the study are prolonged time from injury to fasciotomy, type of fasciotomy, site of injury, and kind of underlying injury. The study was a retrospective analysis of 100 consecutive fasciotomies done for trauma over a period of 38 months (December 1991 to January 1995) in a “level I” trauma center at a university-affiliated county teaching hospital. Ninety-four patients were eligible for analysis, 29 of whom (31%) developed complications at the fasciotomy site. The risk was increased for lower extremity versus upper extremity (34.3% versus 20.8%), prophylactic versus therapeutic (42.0% versus 24.6%), late (>8 hours) versus early (37% versus 25%), and vascular versus musculoskeletal (38.8% versus 22.2%) trauma cases. The same risk factors negatively influenced the ability to close the skin primarily. The four subgroups defined by vascular/nonvascular injury and upper/lower extremity site had significantly different nonclosure rates (p = 0.043). The rate was highest among the vascular/lower extremity group (60.5%) and lowest among the nonvascular/upper extremity group (15.4%). We concluded that fasciotomies in lower extremities, the presence of underlying vascular injuries, fasciotomies performed prophylactically, and a time between the injury and fasciotomy of more than 8 hours are associated with an increased risk for local complications. The same factors are associated with an increased need for skin grafting the wound.

DOI: 10.1007/s002689900224 PMID: 9015166 [Indexed for MEDLINE]

81. Arch Surg. 1995 Sep;130(9):971-5. doi: 10.1001/archsurg.1995.01430090057019.

Penetrating injuries of the neck in patients in stable condition. Physical examination, angiography, or color flow Doppler imaging.

Demetriades D(1), Theodorou D, Cornwell E 3rd, Weaver F, Yellin A, Velmahos G, Berne TV.

Author information: (1)Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.

BACKGROUND: The initial assessment of penetrating injuries of the neck is controversial, with angiography remaining the gold standard for identifying vascular injuries. Recent reports suggest that physical examination might be an accurate way to evaluate these injuries. Color flow Doppler imaging has been used with promising results to assess extremity injuries, but the role of color flow Doppler imaging in neck injuries has not been studied. OBJECTIVE: To evaluate and compare the roles of physical examination, color flow Doppler imaging, and angiography in the identification and management of penetrating neck injuries. STUDY DESIGN: A prospective study of patients in stable condition with penetrating injuries of the neck. All study patients were examined according to a written clinical protocol and subsequently underwent angiography and color flow Doppler imaging. The sensitivity and specificity of physical examination and color flow Doppler imaging were compared with those of angiography. RESULTS: Eighty-two patients fulfilled the criteria for inclusion in the study. Angiography demonstrated vascular lesions in 11 patients (13.4%), but only two (2.4%) of them required treatment. Serious injuries were detected or suspected during physical examination, but six lesions not requiring treatment were missed. When injuries not requiring treatment were excluded, the sensitivity was 100% and the specificity was 91%. With color flow Doppler imaging, 10 of the 11 injuries were identified, for a sensitivity of 91% and a specificity of 98.6%. The sensitivity and specificity were 100% for clinically important lesions. CONCLUSION: The combination of a careful physical examination and color flow Doppler imaging provides a reliable way to assess penetrating neck trauma and may be a safe alternative to routine contrast angiography.

DOI: 10.1001/archsurg.1995.01430090057019 PMID: 7661682 [Indexed for MEDLINE]

82. World J Surg. 1997 Jan;21(1):41-7; discussion 47-8. doi: 10.1007/s002689900191.

Evaluation of penetrating injuries of the neck: prospective study of 223 patients.

Demetriades D(1), Theodorou D, Cornwell E, Berne TV, Asensio J, Belzberg H, Velmahos G, Weaver F, Yellin A.

Author information: (1)Division of Trauma and Critical Care, School of Medicine, University of Southern California, 1510 San Pablo Street, Los Angeles, California 90033, USA.

Comment in World J Surg. 1998 May;22(5):506.

The objective of this study was to assess the role of clinical examination, angiography, color flow Doppler imaging, and other diagnostic tests in identifying injuries to the vascular or aerodigestive structures in patients with penetrating injuries to the neck. A prospective study was made of patients with penetrating neck injuries. All patients had a careful physical examination according to a written protocol. Stable patients underwent routine four-vessel angiography and color flow Doppler imaging. Esophagography and endoscopy were performed for proximity injuries. The sensitivity, specificity, and predictive values of physical examination, color flow Doppler studies, and other diagnostic tests were assessed during the evaluation of vascular and aerodigestive tract structures in the neck. Altogether 223 patients were entered in the study. After physical examination 176 patients underwent angiography and 99 of them underwent color flow Doppler imaging. Angiographic abnormalities were seen in 34 patients for an incidence of 19.3%, but only 14 (8.0%) required treatment. Color flow Doppler imaging was performed on 99 patients with a sensitivity of 91.7%, specificity 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99%. These values were all 100% when only injuries requiring treatment were considered. None of the 160 patients without clinical signs of vascular injury had serious vascular trauma requiring treatment (NPV 100%), although angiography in 127 showed 11 vascular lesions not requiring treatment. “Hard” signs on clinical examination (large expanding hematomas, severe active bleeding, shock not responding to fluids, diminished radial pulse, bruit) reliably predicted major vascular trauma requiring treatment. Among 34 of the 223 total patients (15.2%) admitted with “soft” signs, 8 had angiographically detected injuries, but only one required treatment. An esophagogram was performed on 98 patients because of proximity injuries (49 patients) or suspicious clinical signs (49 patients), and two of them showed esophageal perforations. None of the 167 patients without clinical signs of esophageal trauma had an esophageal injury requiring treatment. It was concluded that physical examination is reliable for identifying those patients with penetrating injuries of the neck who require vascular or esophageal diagnostic studies. Color flow Doppler imaging is a dependable alternative to angiography. An algorithm for the initial assessment of neck injuries is suggested.

DOI: 10.1007/s002689900191 PMID: 8943176 [Indexed for MEDLINE]

83. World J Surg Oncol. 2007 Aug 3;5:87. doi: 10.1186/1477-7819-5-87.

Paraganglioma of the greater omentum: Case report and review of the literature.

Archontovasilis F(1), Markogiannakis H, Dikoglou C, Drimousis P, Toutouzas KG, Theodorou D, Katsaragakis S.

Author information: (1)1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Q, Sofias 114 avenue, 11527 Athens, Greece. markogiannakis@easy.com.

BACKGROUND: Extra-adrenal, intra-abdominal paraganglioma constitutes a rare neoplasm and, moreover, its location in the greater omentum is extremely infrequent. CASE PRESENTATION: A 46-year-old woman with an unremarkable medical history presented with an asymptomatic greater omentum mass that was discovered incidentally during ultrasonographic evaluation due to menstrual disturbances. Clinical examination revealed a mobile, non-tender, well-circumscribed mass in the right upper and lower abdominal quadrant. Blood tests were normal. Contrast-enhanced abdominal computed tomography (CT) scan confirmed a huge (15 x 15 cm), well-demarcated, solid and cystic, heterogeneously enhanced mass between the right liver lobe and right kidney. Exploratory laparotomy revealed a large mass in the greater omentum. The tumor was completely excised along with the greater omentum. Histopathology offered the diagnosis of benign greater omentum paraganglioma. After an uneventful postoperative course, the patient was discharged on the 4th postoperative day. She remains free of disease for 2 years as appears on repeated CT scans as well as magnetic resonance imaging (MRI) and scintigraphy performed with radiotracer-labeled metaiodobenzyl-guanidine (MIBG) scans. CONCLUSION: This is the second reported case of greater omentum paraganglioma. Clinical and imaging data of patients with extra-adrenal, intra-abdominal paragangliomas are variable while many of them may be asymptomatic even when the lesion is quite large. Thorough histopathologic evaluation is imperative for diagnosis and radical excision is the treatment of choice. Since there are no definite microscopic criteria for the distinction between benign and malignant tumors, prolonged follow-up is necessary.

DOI: 10.1186/1477-7819-5-87 PMCID: PMC1976114 PMID: 17683569

84. World J Surg. 2007 Sep;31(9):1854-7. doi: 10.1007/s00268-007-9167-3.

A simplified technique for translaryngeal tracheostomy (TLT). A preliminary report.

Katsaragakis S(1), Theodorou D, Drimousis P, Stamou KM, Koutras A, Kapralou A, Bramis J.

Author information: (1)Surgical Intensive Care Unit, 1st Department of Propaedeutic Surgery, Athens University School of Medicine, Vas. Sofias 114 Ave., Hippocration Hospital, Athens, 11527, Greece.

OBJECTIVE: In this prospective observational study we present preliminary results of a modification of the translaryngeal tracheostomy technique that was introduced by Fantoni in 1997. The study was conducted in a five-bed surgical intensive care unit of a university teaching hospital. PATIENTS AND METHODS: The study included 14 consecutive surgical patients (8 men, 6 women) who underwent a modified translaryngeal tracheostomy in a 6-month period. In our modification of the technique, we keep the basic principle of the inside-to-outside approach of the Fantoni technique, and combine it with a blind needle insertion, as reported in the classic subcricoid retrograde intubation technique. The technique that we use involves two medical doctors and a nurse. RESULTS: Mean patient age was 68.9 years (range: 31-85 years) and mean APACHE II score was 15.8 (range: 6-31). Mean operative time for the procedure was 15.2 min (range: 11.5-22 min). Eight of the patients died during the postoperative course in the ICU from causes relevant to their surgical pathology. One patient survived to be discharged from the ICU but died of an acute myocardial infraction later in the same hospital stay. Five patients survived to be discharged from the hospital. CONCLUSIONS: The modified translaryngeal tracheostomy seems to be as reliable and safe as the original technique. In addition, the modified technique is faster and can be performed without the use of an endoscope.

DOI: 10.1007/s00268-007-9167-3 PMID: 17639388 [Indexed for MEDLINE]

85. J Surg Oncol. 1998 May;68(1):30-3. doi: 10.1002/(sici)1096-9098(199805)68:1<30::aid-jso7>3.0.co;2-m.

Retroperitoneal tumors: do the satellite tumors mean something?

Voros D(1), Theodorou D, Ventouri K, Prachalias A, Danias N, Gouliamos A.

Author information: (1)Second Department of Surgery, School of Medicine, University of Athens, Greece.

BACKGROUND AND OBJECTIVES: Primary retroperitoneal tumors constitute a rather uncommon disease with an incidence of 2 in 100,000. Local recurrence after surgical resection is reported between 60% and 90% at 10 yr. The aim of this study was to present the problem of satellite tumors around the main tumor mass and their possible relation to local recurrence. METHODS: Twenty-nine patients with retroperitoneal tumors underwent surgical resection in our department during an 8-yr period. We reviewed their records including their preoperative computed tomography (CT) scans. RESULTS: Twenty patients had “complete” resections requiring seven nephrectomies, four colectomies, two splenectomies, and one appendectomy. In nine cases the resection was incomplete because of tumor invasion to vital structures. Histopathology revealed that the resected tumors were: liposarcomas (12), leiomyosarcomas (4), paragangliomas (5), malignant fibrous histiocytomas (3), other sarcomas (3), schwannoma (1), myelolipoma (1), and the malignancy grade was I in 6, grade II in 11, and grade III in 12 cases. Two patients died within 30 d of the operation. The I year recurrence rate was 41.4% (12/29) and the total recurrence rate 55.2% (16/29). Survival at 5 yr was 31% (9/29), whereas the disease-free survival was 20.7% (6/29). Four patients required reoperations. In seven cases (24,1%) preoperative CT scans revealed small nodular lesions around the main tumor that were removed en bloc and were of the same histopathological type as the main tumor. We called these “satellite” tumors. All seven patients had local recurrence within 1 yr. CONCLUSIONS: There seems to be a close relationship between the finding of satellite tumors and the recurrence of the disease. The existence of satellite tumors on the preoperative CT scan may be used as a guide for the extent of the resection, and further investigations are necessary before they are used as a prognostic sign.

DOI: 10.1002/(sici)1096-9098(199805)68:1<30::aid-jso7>3.0.co;2-m PMID: 9610660 [Indexed for MEDLINE]

86. Clin Oncol (R Coll Radiol). 2011 Nov;23(9):653; author reply 653. doi: 10.1016/j.clon.2011.07.004. Epub 2011 Jul 28.

Reply to: Definitive chemoradiation for oesophageal cancer–a standard of care in patients with non-metastatic oesophageal cancer.

Doulami G, Theodorou D.

Comment on Clin Oncol (R Coll Radiol). 2011 Apr;23(3):182-8.

DOI: 10.1016/j.clon.2011.07.004 PMID: 21798730 [Indexed for MEDLINE]

87. Tumori. 2006 Nov-Dec;92(6):540-1.

Pretreatment tumor lysis syndrome associated with bulky retroperitoneal tumors. Recognition is the mainstay of therapy.

Theodorou D(1), Lagoudianakis E, Pattas M, Drimousis P, Tsekouras DK, Genetzakis M, Katergiannakis V, Manouras A.

Author information: (1)First Department of Propaedeutic Surgery, Hippocrateion Hospital, Athens Medical School, University of Athens, Athens, Greece.

Acute pretreatment tumor lysis syndrome is a rare complication of cancer. Early recognition and aggressive management are mandatory for prevention of the adverse sequelae of the syndrome. Here we present 2 cases of pretreatment tumor lysis syndrome, concluding that this clinical entity should be in the differential diagnosis of acute renal failure associated with malignancy, as early recognition is in fact the mainstay of treatment.

PMID: 17260497 [Indexed for MEDLINE]

88. Ann Thorac Surg. 2002 May;73(5):1645-7. doi: 10.1016/s0003-4975(01)03464-6.

Bullets and biliptysis.

Nigro JJ(1), Arroyo H Jr, Theodorou D, Velmahos GC, Bremner RM.

Author information: (1)Department of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles County University of Southern California Medical Center, 90033, USA. jnigro@hsc.usc.edu

Biliptysis is a dramatic physical finding which suggests the presence of a direct communication (fistula) between the biliary and bronchial tree. We report a bronchial biliary fistula resulting from penetrating thoracoabdominal trauma and the use of positive-pressure ventilation to obtain initial fistula control prior to definitive surgical repair.

DOI: 10.1016/s0003-4975(01)03464-6 PMID: 12022574 [Indexed for MEDLINE]

89. J Med Case Rep. 2009 Nov 24;3:9292. doi: 10.1186/1752-1947-3-9292.

Complete abdominal aortic aneurysm thrombosis and obstruction of both common iliac arteries with intrathrombotic pressures demonstrating a continuing risk of rupture: a case report and review of the literature.

Filis KA(1), Lagoudianakis EE, Markogiannakis H, Kotzadimitriou A, Koronakis N, Bramis K, Xiromeritis K, Theodorou D, Manouras A.

Author information: (1)1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece.

INTRODUCTION: Although mural thrombus in an abdominal aortic aneurysm is frequent and its role has been studied extensively, complete thrombosis of an abdominal aneurysm is extremely rare and its natural history in relation to the risk of rupture is not known. The case of a patient with a completely thrombosed infrarenal aneurysm is presented along with a literature review. CASE PRESENTATION: We report the case of a 56-year-old Caucasian man with an infrarenal abdominal aortic aneurysm, presenting at our hospital due to critical ischemia of his right lower limb. Computed tomography and angiography demonstrated complete aneurysm thrombosis and obstruction of both common iliac arteries. CONCLUSION: During the operation, systolic and mean intrathrombotic pressures, measured in different levels, constituted 74.5-90.2% and 77.5-92.5% of systolic and mean intraluminal pressure and 73-88.4% and 76.5-91.3% of systemic pressure, respectively. Our findings show that there may be a continuing risk of rupture in cases of a thrombosed abdominal aortic aneurysm.

DOI: 10.1186/1752-1947-3-9292 PMCID: PMC2803815 PMID: 20062781