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Persistent omphalomesenteric duct causing small bowel obstruction in an adult

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World Journal of Gastroenterology 2007年第15期13卷 2258-2260页

作者： Haridimos Markogiannakis dimitrios theodorou Konstantinos G Toutouzas Panagiotis Drimousis Sotirios Georgios Panoussopoulos Stilianos Katsaragakis Department of Propaedeutic Surgery Hippokration Hospital Athens Medical SchoolUniversity of AthensVasilissis Sofias 114 Avenue11527AthensGreece

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.

关键词： Persistent omphalomesenteric duct Small bowel obstruction Adult patient

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

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World Journal of Gastroenterology 2007年第8期13卷 1289-1291页

作者： Chryssostomos Kalantzis Periklis Apostolopoulos Panagiota Mavrogiannis dimitrios theodorou Xenophon Papaharalampous Ioannis Bramis Nikolaos Kalantzis Gastroenterology Department NIMTS Hospital 10-12 Monis Petraki str. Athens Greece 1st Propedeutic Surgical Clinic University of Athens Medical School Hippocration Hospital Athens Greece Radiology Department University of Athens Medical School Areteion Hospital 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.

关键词： Capsule endoscopy Retention Small bowel obstruction Obscure gastrointestinal bleeding Surgery

Acute esophageal necrosis: A systematic review and pooled analysis

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World Journal of Gastrointestinal Surgery 2020年第3期12卷 104-115页

作者： dimitrios Schizas Nikoletta A Theochari Konstantinos S Mylonas Prodromos Kanavidis Eleftherios Spartalis Stamatina Triantafyllou Konstantinos P Economopoulos dimitrios theodorou Theodore Liakakos First Department of Surgery National and Kapodistrian University of AthensLaikon General HospitalAthens 11527Greece Department of Medicine Surgery Working GroupSociety of Junior DoctorsAthens 15122Greece Laboratory of Experimental Surgery and Surgical Research N.S.Christeas National and Kapodistrian University of AthensAthens 11527Greece First Propedeutic Department of Surgery National and Kapodistrian University of AthensHippocration General HospitalAthens 11527Greece Department of Surgery Duke University Medical CenterDurhamNC 27708United States

BACKGROUND Acute esophageal necrosis(AEN)is a rare entity with multifactorial etiology,usually presenting with signs of upper gastrointestinal *** To systematically review all available data on demographics,clinical features,outcomes and management of this medical *** 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 *** Seventy-nine studies were included in this ***,114 patients with AEN were identified,of whom 83 were males and 31 *** patient age was 62.1±*** 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 *** overall followup was 66.2±101.8 *** 29.9%of patients died either during the initial hospital stay or during the follow-up *** 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 *** the frequency of surgical and endoscopic intervention has increased in recent years,outcomes have remained the ***,further research work is needed to better understand how to best treat this potentially lethal disease.

关键词： Acute esophageal necrosis Black esophagus Acute necrotizing esophagitis

A new pancreaticojejunostomy technique: A battle against postoperative pancreatic fistula

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World Journal of Gastroenterology 2013年第27期19卷 4351-4355页

作者： Stylianos Katsaragakis Andreas Larentzakis Sotirios-Georgios Panousopoulos Konstantinos G Toutouzas dimitrios theodorou Spyridon Stergiopoulos Georgios Androulakis 1st Department of Propaedeutic Surgery Athens Medical SchoolHippocratio Athens General HospitalUniversity of Athens

AIM:To present a new technique of end-to-side, ductto-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.

关键词： Whipple Pancreaticojejunostomy Technique Seromuscular jejunal flap Pancreatic fistula

Transjugular intrahepatic portosystemic shunt for recompensating decompensated cirrhosis?

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World Journal of Gastroenterology 2024年第20期30卷 2621-2623页

作者： dimitrios S Karagiannakis Academic Department of Gastroenterology and Hepatology Medical School of National and Kapodistrian University of AthensGeneral Hospital of Athens“Laiko”Athens 11527Greece

Transjugular intrahepatic portosystemic shunt(TIPS)is a medical procedure that has been used to manage variceal bleeding and ascites in patients with *** can prevent further decompensation and improve the survival of high-risk decompensated *** research indicates that TIPS could increase the possibility of recompensation of decompensated cirrhosis when it is combined with adequate suppression of the causative factor of liver ***,the results of the studies have been based on retrospective analysis,and further validation is required by conducting randomized controlled *** this context,we highlight the limitations of the current studies and emphasize the issues that must be addressed before TIPS can be recommended as a potential recompensating tool.

关键词： Decompensated cirrhosis Liver recompensation Baveno VII Transjugular intrahepatic portosystemic shunt

Optimal Offering of Energy Storage in UK Day-Ahead Energy and Frequency Response Markets

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Journal of Modern Power Systems and Clean Energy 2024年第2期12卷 415-426页

作者： Makedon Karasavvidis Andreas Stratis dimitrios Papadaskalopoulos Goran Strbac Department of Electrical and Electronic Engineering Imperial College LondonLondonUK Statkraft UK Ltd. LondonUK Department of Electrical and Computer Engineering University of PatrasPatrasGreece IEEE

The offering strategy of energy storage in energy and frequency response(FR) markets needs to account for country-specific market regulations around FR products as well as FR utilization factors, which are highly uncertain. To this end, a novel optimal offering model is proposed for stand-alone price-taking storage participants, which accounts for recent FR market design developments in the UK, namely the trade of FR products in time blocks, and the mutual exclusivity among the multiple FR products. The model consists of a day-ahead stage, devising optimal offers under uncertainty, and a real-time stage, representing the storage operation after uncertainty is materialized. Furthermore, a concrete methodological framework is developed for comparing different approaches around the anticipation of uncertain FR utilization factors(deterministic one based on expected values, deterministic one based on worst-case values, stochastic one, and robust one), by providing four alternative formulations for the real-time stage of the proposed offering model, and carrying out an out-of-sample validation of the four model instances. Finally, case studies employing real data from UK energy and FR markets compare these four instances against achieved profits, FR delivery violations, and computational scalability.

关键词： Energy markets energy storage frequency response optimal offering robust optimization stochastic programming

Minimally invasive pelvic exenteration for primary or recurrent locally advanced rectal cancer:A glimpse into the future

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 1960-1964页

作者： dimitrios Kehagias Charalampos Lampropoulos Ioannis Kehagias Department of General Surgery General University Hospital of PatrasPatras 26504Greece Intensive Care Unit Saint Andrew’s General HospitalPatras 26335Greece Division of Bariatric and Metabolic Surgery Department of SurgeryUniversity of PatrasPatras 26504Greece

Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer(LARC)for many *** main objectives are to increase the overall survival and quality of life of the patients and to mitigate postoperative ***,pelvic exenteration(PE)with or without neoadjuvant treatment is a curative treatment when negative resection margins are *** traditional open approach has been favored by many ***,the technological advancements in minimally invasive surgery have radically changed the surgical *** studies have demonstrated promising results in postoperative complications and oncological outcomes after robotic or laparoscopic PE.A recent retrospective study entitled“Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review”was published in the World Journal of Gastrointestinal *** we read this article with great interest,we decided to delve into the latest data regarding the benefits and risks of minimally invasive PE for ***,the small number of suitable patients,limited surgeon experience,and steep learning curve are hindering the establishment of minimally invasive PE.

关键词： Locally advanced rectal cancer Pelvic exenteration Multivisceral resection Minimally invasive surgical procedures Robotic surgical procedures

Downstaging strategies for unresectable hepatocellular carcinoma

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World Journal of Gastroenterology 2024年第20期30卷 2731-2733页

作者： Georgia Sofia Karachaliou Nikolaos Dimitrokallis dimitrios P Moris Division of Gastroenterology Department of MedicineDuke University Medical CenterDurhamNC 27710United States First Department of Surgery&Organ Transplant Unit Evangelismos General HospitalAthens 10676Greece Department of Surgery Duke University Medical CenterDurhamNC 27710United States

A significant number of patients with hepatocellular carcinoma(HCC)are usually diagnosed in advanced stages,that leads to inability to achieve *** options are focusing on downstaging a locally advanced *** is wellsupported in the literature that patients with HCC who undergo successful conversion therapy followed by curative-intent surgery may achieve a significant survival benefit compared to those who receive chemotherapy alone or those who are successfully downstaged with conversion therapy but not treated with *** artery infusion chemotherapy can be a potential downstaging strategy,since recent studies have demonstrated excellent outcomes in patients with colorectal liver metastatic disease as well as primary liver malignancies.

关键词： Unresectable hepatocellular carcinoma Hepatic arterial infusion chemotherapy Downstaging Hepatocellular carcinoma

Time to say goodbye: from Barcelona to Milan and the modern management of hepatocellular carcinoma

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Hepatobiliary Surgery and Nutrition 2024年第3期13卷 548-550页

作者： Georgia Sofia Karachaliou Nikolaos Dimitrokallis dimitrios Moris Division of Gastroenterology Department of MedicineDuke University Medical CenterDurhamNCUSA st Department of Surgery&Organ Transplant Unit Evangelismos General HospitalAthensGreece Department of Surgery Duke University Medical CenterDurhamNCUSA

Hepatocellular carcinoma(HCC)is the most common primary liver malignancy and one of the most common causes of cancer-related death with the projection to increase during the next few decades(1).During the last 3 decades,several staging systems have been introduced for the stratification of the prognosis and management of HCC of all *** is no consensus regarding the universal implementation of one staging system since all the proposed classifications have limitations(2).The Barcelona Clinic Liver Cancer(BCLC)Staging System remains the most widely classification system used for HCC management guidelines that incorporates tumor size,presence of metastatic disease,portal hypertension,Child-Turcotte-Pugh score,total bilirubin and performance ***,it does not account for tumoral behavior,and it is very“conservative”(restrictive)regarding resectability,especially for BCLC-B patients who might benefit from surgical management(3,4).Recent advances in systemic and locoregional therapies have led to changes in many guidelines regarding systemic therapy,as well as the possibility for downstaging patients to undergo surgery or transplant with curative intent.

关键词： Hepatocellular carcinoma(HCC) Barcelona Clinic Liver Cancer(BCLC) tumor burden score