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World Journal of Clinical Cases 2024年第30期12卷 6413-6416页

作者： dimitrios S Karagiannakis Academic Department of Gastroenterology Medical School of the National and Kapodistrian University of Athens"Laiko"General HospitalAthens 11527Greece

Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an *** these cases,palliative care and mechanical widening of the blocked biliary system are *** insertion of a stent is often necessary to prevent the recurrence of blockages caused by cancer *** to stent placement,endo-biliary radiofrequency ablation(EB-RFA)appears to result in longer-lasting stent effectiveness without increasing the risk of severe ***,its impact on overall survival is not yet ***,while endoscopic retrograde cholangiopancreatography is the most common method for performing EB-RFA,percutaneous transhepatic cholangiodrainage seems to be a safe and potentially more efficient alternative,particularly for long,angulated,or significantly narrowed bile ducts.

关键词： Biliary cancer Cholangiocarcinoma Pancreatic cancer Percutaneous transhepatic cholangiodrainage Radiofrequency ablation

Prognostic nutritional index in predicting survival of patients with gastric or gastroesophageal junction adenocarcinoma: A systematic review

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 514-526页

作者： Stylianos Fiflis Grigorios Christodoulidis Menelaos Papakonstantinou Alexandros Giakoustidis Stergos Koukias Paraskevi Roussos Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas dimitrios Giakoustidis First Department of Surgery General Hospital PapageorgiouThessaloniki 56429Greece Department of General Surgery University Hospital of LarissaLarissa 41110Greece

BACKGROUND Gastric cancer is the third most common cause of cancer related death *** with or without chemotherapy is the most common approach with curative intent;however,the prognosis is poor as mortality rates remain *** indexes have been proposed in the past few years in order to estimate the survival of patients undergoing *** preoperative nutritional status of gastric cancer patients has recently gained attention as a factor that could affect the postoperative course and various indexes have been *** aim of this systematic review was to assess the role of the prognostic nutritional index(PNI)in predicting the survival of patients with gastric or gastroesophageal adenocarcinoma who underwent gastrectomy with curative *** To investigate the role of PNI in predicting the survival of patients with gastric or gastroesophageal junction *** A thorough literature search of PubMed and the Cochrane library was performed for studies comparing the overall survival(OS)of patients with gastric or gastroesophageal cancer after surgical resection depending on the preoperative PNI *** PRISMA algorithm was used in the screening process and finally 16 studies were included in this systematic *** review protocol was registered in the International Prospective Register of Systematic Reviews(PRO) RESULTS Sixteen studies involving 14551 patients with gastric or esophagogastric junction adenocarcinoma undergoing open or laparoscopic or robotic gastrectomy with or without adjuvant chemotherapy were included in this systematic *** patients were divided into high-and low-PNI groups according to cut-off values that were set according to previous reports or by using receiver operating characteristic curve analysis in each individual *** 5-year OS of patients in the low-PNI groups ranged between 39%and 70.6%,while in the high-PNI groups,it ranged between 54.9%and 95.8%.In most of the included st

关键词： Prognostic nutritional index Gastric adenocarcinoma Gastroesophageal junction cancer Prognosis Overall survival

The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation:A randomized,physiological,crossover study

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Journal of Intensive Medicine 2024年第2期4卷 202-208页

作者： Elena Lytra Stelios Kokkoris Ioannis Poularas dimitrios Filippiadis Demosthenes Cokkinos dimitrios Exarhos Spyros Zakynthinos Christina Routsi 1st Department of Intensive Care Medical SchoolNational and Kapodistrian University of AthensEvangelismos HospitalAthensGreece Radiology Department Evangelismos HospitalAthensGreece 2nd Radiology Department Medical SchoolNational and Kapodistrian University of AthensAttikon HospitalAthensGreece

Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical *** data exist on whether such effects are also present in HFOT through ***,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical *** A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical *** patients underwent a 30-min spontaneous breathing trial(SBT)and received oxygen either via T-piece or by HFOT through tracheostomy,followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover *** the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(VT)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle *** Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied *** were randomly assigned to start the SBT with a T-piece(n=10 sessions)or with HFOT(n=9 sessions).With HFOT,VT and minute ventilation(VE)significantly increased during SBT(from[465±119]mL to[549±134]mL,P<0.001 and from[12.4±4.3]L/min to[13.1±4.2]L/min,P<0.05,respectively),but they did not change significantly during SBT with T-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/VT decreased during HFOT(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),P<0.001),but it did not change significantly during SBT with T-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(m

关键词： Diaphragm Diaphragm ultrasonography High-flow oxygen Prolonged mechanical ventilation Tracheostomy

Traumatic lumbar hernia: A systematic review of the literature

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Chinese Journal of Traumatology 2024年第1期27卷 53-57页

作者： Ioannis Tsouknidas Nikolaos Tasis Maria Ioanna Antonopoulou Vasileios Acheimastos dimitrios KManatakis Department of Surgery Stony Brook University HospitalStony BrookNew YorkUSA Department of Surgical Oncology St Savvas Cancer HospitalAthensGreece nd Department of Surgery Athens Naval and Veterans HospitalAthensGreece Department of Surgery Naval Hospital of CreteChaniaGreece

Purpose:Traumatic lumbar hernia(TLH)constitutes a protrusion of content through a defect in the posterior abdominal wall,as a result of *** rare entity has been described in limited number of ***:A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology *** English literature from 1990 until 2021 was reviewed,using PubMed,EMBASE and Google Scholar bibliographic databases,to identify case reports and case series with patients that were diagnosed with *** each eligible study,demographics,clinical presentation,hernia characteristics,preoperative imaging investigations,operation details,and postoperative data were extracted for *** analysis was performed on SPSS,version ***:A total of 62 studies were included for review,with 164 patients with *** age was(42.6±14.3)years(47.6%males,31.1%females,gender not specified in 35 cases).Mean diameter of hernia neck was(6.3±3.1)cm,while the triangles of Petit and Grynfeltt were affected in 74.5%and 14.6%,*** diagnosed in the emergency setting account for 54.2%,with CT scan establishing diagnosis in all but one case(97.7%).A delayed diagnosis was made in 45.8%,at a mean 1 year following *** bulging(82.8%)and chronic back pain(34.3%)were the most frequent *** both delayed and acute group,open surgery(63.6%and 92.3%,respectively)was the preferred surgical *** complications were reported in 11.4%of acute and 15.0%of delayed *** recurrence was 7%.Conclusions:TLH is uncommon with 164 cases described since *** scan is the gold standard in *** surgery is generally the preferred approach,particularly in the emergency *** TLH can be treated either by primary suture repair or mesh,depending on the local conditions,whereas delayed cases usually require a mesh.

关键词： Lumbar hernia Petit Grynfeltt Traumatic lumbar hernia Trauma

Impact of bisphosphonate treatment on bone mineral density after kidney transplant

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World Journal of Transplantation 2024年第3期14卷 102-109页

作者： Georgia Andriana Georgopoulou Marios Papasotiriou Theodoros Ntrinias Eirini Savvidaki dimitrios S Goumenos Evangelos Papachristou Department of Nephrology and Kidney Transplantation University Hospital of PatrasPatras 26504Greece

BACKGROUND Mineral bone disease is associated with chronic kidney disease and persists after kidney *** treatment contributes to the patho-genesis of this *** treatments have shown positive but inde-finite *** To evaluate the effectiveness and safety of bisphosphonate treatment on post kidney transplantation bone mineral density(BMD).METHODS We included kidney transplant recipients(KTRs)whose BMD was measured after the operation but before the initiation of treatment and their BMD was measured at least one year *** also evaluated the BMD of KTRs using two valid mea-surements after transplantation who received no treatment(control group).RESULTS Out of 254 KTRs,62(39 men)were included in the *** were initiated in 35 KTRs in total(20 men),1.1±2.4 years after operation and for a period of 3.9±2.3 years while 27(19 men)received no *** improved significantly in KTRs who received bisphosphonate treatments(from-2.29±1.07 to-1.66±1.09,P<0.0001).The control group showed a non-significant decrease in BMD after 4.2±1.4 years of follow-up after *** function was not affected by bisphosphonate *** KTRs with established osteoporosis,active treatment had a similar and significant effect on those with osteopenia or normal bone *** In this retrospective study of KTRs receiving bisphosphonate treatment,we showed that active treatment is effective in preventing bone loss irrespective of baseline BMD.

关键词： Mineral and bone disorders Chronic kidney disease Kidney transplant recipients Bisphosphonates Bone mineral density

Stent A pancreaticojejunostomy after pancreatoduodenectomy:Is it always necessary?

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World Journal of Methodology 2024年第3期14卷 23-29页

作者： dimitrios Symeonidis Dimitris Zacharoulis Georgios Tzovaras Labrini Kissa Athina A Samara Eleana Petsa Konstantinos Tepetes Department of Surgery University Hospital of LarissaLarissa 41110Greece Department of General Surgery University Hospital of LarissaLarissa 41110Greece

The establishment of a postoperative pancreatic fistula(POPF)is considered the most common and,concomitantly,the most serious complication associated with pancreaticoduodenectomy(PD).The search for either technical modifications of the operative technique or pharmaceutical interventions that could possibly aid in decreasing the incidence of this often-devastating complication appears *** stenting of the pancreatic duct,with the use of either internal or external stents,has been evaluated in this *** theory,it is an approach that could eliminate many pathophysiological factors responsible for the occurrence of a *** purpose of the present study was to review the current data regarding the role of pancreatic duct stenting on the incidence of POPF,after PD,by using PubMed and Reference Citation *** general,previous studies seem to highlight the superiority of external stents over their internal counterparts in regard to the incidence of POPF;this is at the cost,however,of increased morbidity associated mainly with the stent ***,the use of an internal stent is a less invasive approach with acceptable results and is definitely deprived of the drawbacks arising through the complete diversion of pancreatic juice from the gastrointestinal *** in mind the scarcity of high-quality data on the subject,an approach of reserving stent placement for the high-risk for POPF patients and individualizing the selection between the use of an internal or an external stent according to the distinct characteristics of each individual case scenario appears appropriate.

关键词： Pancreaticoduodenectomy Postoperative pancreatic fistula Pancreatic stent Pancreaticojejunostomy

Effect of growth hormone on colonic anastomosis after intraperitoneal administration of 5-fluorouracil, bleomycin and cisplatin: An experimental study

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World Journal of Gastrointestinal Surgery 2024年第8期16卷 2679-2688页

作者： Ioannis Lambrou Ioannis Mantzoros Orestis Ioannidis dimitrios Tatsis Elissavet Anestiadou Vasiliki Bisbinas Manousos-Georgios Pramateftakis Efstathios Kotidis Barbara Driagka Ourania Kerasidou Savvas Symeonidis Stefanos Bitsianis Freideriki Sifaki Konstantinos Angelopoulos Haralabos Demetriades Stamatios Angelopoulos Fourth Department of Surgery Medical SchoolAristotle University of ThessalonikiThessaloniki 57010Greece Department of ENT Royal Cornwall Hospitals NHS TrustCornwall TR13LJUnited Kingdom

BACKGROUND Growth hormone(GH)plays a crucial role in wound healing and tissue repair in postoperative *** particular,colonic anastomosis healing following colorectal surgery is impaired by numerous chemotherapy *** To investigate whether GH can improve the healing of a colonic anastomosis following the adverse effects of intraperitoneal administration of 5-fluorouracil(5-FU),bleomycin and *** Eighty Wistar rats underwent laparotomy and a 1 cm-resection of the transverse colon,followed by an end-to-end anastomosis under general *** rats were blindly allocated into four equal groups and administered a different daily intraperitoneal therapeutic regimen for 6 *** control group(A)received normal *** B received chemotherapy with 5-FU(20 mg/kg),bleomycin(4 mg/kg)and cisplatin(0.7 mg/kg).Group C received GH(2 mg/kg),and group D received the aforementioned combination chemotherapy and GH,as *** rats were sacrificed on the 7th postoperative day and the anastomoses were macroscopically and microscop-ically *** weight,bursting pressure,hydroxyproline levels and inflammation markers were *** All rats survived until the day of sacrifice,with no infections or other complications.A decrease in the body weight of group D rats was observed,not statistically significant compared to group A(P=1),but significantly different to groups C(P=0.001)and B(P<0.01).Anastomotic dehiscence rate was not statistically different between the *** pressure was not significantly different between groups A and D(P=1.0),whereas group B had a significantly lower bursting pressure compared to group D(P<0.001).All groups had significantly more adhesions than group ***,as a measurement of collagen deposition,was significantly higher in group D compared to group B(P<0.05),and higher,but not statistically significant,compared to group *** changes in group D were recorded,compared to group A

关键词： Growth hormone Colonic anastomosis Adhesion Bursting pressure Collagen Hydroxyproline Inflammation Neoangiogenesis Chemotherapy

Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

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World Journal of Transplantation 2024年第2期14卷 107-118页

作者： Sophia Hatzianastasiou Paraskevas Vlachos Georgios Stravopodis dimitrios Elaiopoulos Afentra Koukousli Josef Papaparaskevas Themistoklis Chamogeorgakis Kyrillos Papadopoulos Theodora Soulele Despoina Chilidou Kyriaki Kolovou Aggeliki Gkouziouta Michail Bonios Stamatios Adamopoulos Stavros Dimopoulos Microbiology Department and Infection Control Office Onassis Cardiac Surgery CenterAthens 17674Greece Heart Transplantation Unit Onassis Cardiac Surgery CenterAthens 17674Greece Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece

BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive *** To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition,as well as the impact of MDRO acquisition on intensive care unit(ICU)and hospital length of stay,and on ICU mortality and 1-year mortality post heart *** This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period(2013-2022)in a single transplantation *** was collected regarding MDROs commonly encountered in critical *** Among the 98 transplanted patients(70%male),about a third(32%)acquired or already harbored MDROs upon transplantation(MDRO group),while two thirds did not(MDRO-free group).The prevalent MDROs were Acinetobacter baumannii(14%),Pseudomonas aeruginosa(12%)and Klebsiella pneumoniae(11%).Compared to MDRO-free patients,the MDRO group was characterized by higher body mass index(P=0.002),higher rates of renal failure(P=0.017),primary graft dysfunction(10%vs 4.5%,P=0.001),surgical re-exploration(34%vs 14%,P=0.017),mechanical circulatory support(47%vs 26%P=0.037)and renal replacement therapy(28%vs 9%,P=0.014),as well as longer extracorporeal circulation time(median 210 vs 161 min,P=0.003).The median length of stay was longer in the MDRO group,namely ICU stay was 16 vs 9 d in the MDRO-free group(P=0.001),and hospital stay was 38 vs 28 d(P=0.006),while 1-year mortality was higher(28%vs 7.6%,log-rank-χ2:7.34).CONCLUSION Following heart transplantation,a predominance of Gram-negative MDROs was *** acquisition was associated with higher complication rates,prolonged ICU and total hospital stay,and higher post-transplantation mortality.

关键词： Heart transplantation Multi drug resistant organisms Transplantation complications Transplantation outcome

Recent advances in the diagnostic methods and therapeutic strategies of transthyretin cardiac amyloidosis

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World Journal of Cardiology 2024年第7期16卷 370-379页

作者： Christos Kourek Alexandros Briasoulis dimitrios E Magouliotis Panagiotis Georgoulias Grigorios Giamouzis Filippos Triposkiadis John Skoularigis Andrew Xanthopoulos Clinical Ergospirometry Exercise and Rehabilitation Laboratory1^(st)Critical Care Medicine DepartmentEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece Department of Clinical Therapeutics Alexandra HospitalFaculty of MedicineNational and Kapodistrian University of AthensAthens 11528Greece Department of Cardiothoracic Surgery University of ThessalyLarissa BiopolisLarissa 41110Greece Department of Nuclear Medicine University Hospital of LarissaLarissa 41110Greece Department of Cardiology School of MedicineUniversity Hospital of LarissaLarissa 41110Greece

Cardiac amyloidosis is a progressive disease characterized by the buildup of amyloid fibrils in the extracellular space of the *** is divided in 2 main types,immunoglobulin light chain amyloidosis and transthyretin amyloidosis(ATTR),and ATTR amyloidosis is further divided in 2 subtypes,non-hereditary wild type ATTR and hereditary mutant variant *** and prevalence of ATTR cardiac amyloidosis is increasing over the last years due to the improvements in diagnostic *** rates are improving due to the development of novel therapeutic *** is the only disease-modifying approved therapy in ATTR amyloidosis so ***,the most recent advances in medical therapies have added more options with the potential to become part of the therapeutic armamentarium of the *** including acoramidis,eplontersen,vutrisiran,patisiran and anti-monoclonal antibody NI006 are being investigated on cardiac function in large,multicenter controlled trials which are expected to be completed within the next 2-3 years,providing promising results in patients with ATTR cardiac ***,further and ongoing research is required in order to improve diagnostic methods that could provide an early diagnosis,as well as survival and quality of life of these patients.

关键词： Transthyretin cardiac amyloidosis Tafamidis Acoramidis Eplontersen Vutrisiran Patisiran

Overview of the Association Between Non-Alcoholic Fatty Liver Disease and Hypertension

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Cardiology Discovery 2024年第1期4卷 30-37页

作者： Niki S.Kakouril Costas G.Thomopoulos Eirini P.Siafi Angeliki E.Valatsoul Kyriakos S.Dimitriadis Iliana P.Mani Sotirios P.Patsilinakos dimitrios M.Tousoulis Konstantinos P.Tsioufis First Department of Cardiology Medical SchoolNational and Kapodistrian University of AthensHippokration HospitalAthens 11527Greece Department of Cardiology Elena Venizelou HospitalAthens 11521Greece Department of Cardiology General Hospital Agia OlgaAthens 14233Greece

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, and its prevalence is rising. NAFLD is closely associated with metabolic syndrome, with both conditions sharing common clinical characteristics such as obesity, insulin resistance, type 2 diabetes mellitus, hypertension, and hypertriglyceridemia. Several observational studies have evaluated the relationship between NAFLD and hypertension, with the overall evidence suggesting a bidirectional relationship. It is hypothesized that activation of the sympathetic nervous and renin-angiotensin systems, observed in NAFLD with or without insulin resistance promotes the development of hypertension. In patients with hypertension, activation of these systems can lead to hepatic fibrosis and progressive inflammation through increased oxidative stress and activation of hepatic stellate cells and Kupffer cells. The present review examines the pathophysiologic and clinical evidence supporting the bidirectional association between NAFLD and hypertension.

关键词： Hypertension Non-alcoholic fatty liver disease Insulin resistance Sympathetic nervous system Metabolic syndrome