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Two-level reconstruction of isolated fracture of the lesser tuberosity of the humerus

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World Journal of Clinical Cases 2014年第6期2卷 219-223页

作者： Vasileios S Nikolaou Dimitrios Chytas evangelos Tyrpenou George C Babis 2~(nd) Orthopaedic Department Athens University

Fractures of the lesser tuberosity of the humerus are typically met in combination with other injuries of the shoulder. Case reports of isolated lesser tuberosity fractures are particularly rare and, consequently,therapeutic protocols have not yet been completely clarified. Conservative as well as surgical treatment has been recommended, while several operative techniques have been applied. We present a case of a 39-yearold man with an isolated lesser tuberosity fracture who was treated surgically in our institution. Due to fracture comminution, a two-level reconstruction technique with headless screws and buttress plate was applied. As far as we know, this method of fixation of this type of fracture has not been previously described in the *** patient tolerated the procedure well and excellent results were obtained at the latest follow-up.

关键词： Shoulder Humerus Lesser tuberosity Fixation Technique Two-level reconstruction

Combined hepatocellular-cholangiocarcinoma:An update on epidemiology,classification,diagnosis and management

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Hepatobiliary & Pancreatic Diseases International 2020年第6期19卷 515-523页

作者： Dimitrios Schizas Aikaterini Mastoraki Eleni Routsi Michail Papapanou Dimitrios Tsapralis Pantelis Vassiliu Konstantinos Toutouzas evangelos Felekouras First Department of Surgery National and Kapodistrian University of AthensLaikon General HospitalAthensGreece Fourth Department of Surgery National and Kapodistrian University of AthensAttikon University HospitalAthensGreece Surgical Department General Hospital of IerapetraIerapetraGreece First Department of Propaedeutic Surgery National and Kapodistrian University of AthensHippocration HospitalAthensGreece

Background:Combined hepatocellular-cholangiocarcinoma(CHC)is a rare subtype of primary hepatic malignancies,with variably reported incidence between 0.4%–14.2%of primary liver cancer *** study aimed to systematically review the epidemiological,clinicopathological,diagnostic and therapeutic data for this rare *** sources:We reviewed the literature of diagnostic approach of CHC with special reference to its clinical,molecular and histopathological *** analysis of the recent literature in order to evaluate the results of surgical and systemic treatment of this entity has been ***:The median age at CHC’s diagnosis appears to be between 50 and 75 *** of tumor markers[alpha fetoprotein(AFP),carbohydrate antigen 19–9(CA19–9)and carcinoembryonic antigen(CEA)]along with imaging patterns provides better opportunities for CHC’s preoperative *** clinicopathologic prognostic parameters possibly correlated with increased tumor recurrence and grimmer survival odds include advanced age,tumor size,nodal and distal metastases,vascular and regional organ invasion,multifocality,decreased capsule formation,stem-cell features verification and increased GGT as well as CA19–9 and CEA *** case of inoperable or recurrent disease,combinations of cholangiocarcinoma-directed systemic agents display superior results over ***-directed methods,such as transarterial chemoembolization(TACE),percutaneous ethanol injection(PEI),hepatic arterial infusion chemotherapy(HAIC),radioembolization and ablative therapies,demonstrate inferior efficacy than in cases of hepatocellular carcinoma(HCC)due to CHC’s common ***:CHC demonstrates an overlapping clinical and biological pattern between its malignant *** history of the disease seems to be determined by the predominant tumor *** standard for diagnosis is histology of surgical *** therapeutic int

关键词： Combined hepatocellular-cholangiocarcinoma Classification Diagnostic approach Therapeutic management

Addition of senna improves quality of colonoscopy preparation with magnesium citrate

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World Journal of Gastroenterology 2009年第14期15卷 1759-1763页

作者： Stergios Vradelis evangelos Kalaitzakis Yalda Sharifi Otto Buchel Satish Keshav Roger W Chapman Barbara Braden Department of Gastroenterology John Radcliffe Hospital Oxford OX3 9DU United Kingdom Section of Gastroenterology and Hepatology Department of Internal Medicine Sahlgrenska University Hospital 41345 Gothenburg Sweden

AIM: To prospectively investigate the effectiveness and patient’s tolerance of two low-cost bowel cleansing preparation protocols based on magnesium citrate only or the combination of magnesium citrate and senna. METHODS: A total of 342 patients who were referred for colonoscopy underwent a colon cleansing protocol with magnesium citrate alone (n = 160) or magnesium citrate and senna granules (n = 182). The colonoscopist rated the overall efficacy of colon cleansing using an established score on a 4-point scale. Patients were questioned before undergoing colonoscopy for side effects and symptoms during bowel preparation. RESULTS: The percentage of procedures rescheduled because ofinsufficient colon cleansing was 7% in the magnesium citrate group and 4% in the magnesium citrate/senna group (P = 0.44). Adequate visualization of the colonic mucosa was rated superior under the citramag/senna regimen (P = 0.004). Both regimens were well tolerated, and did not significantly differ in the occurrence of nausea, bloating or ***, abdominal cramps were observed more often under the senna protocol (29.2%) compared to the magnesium citrate only protocol (9.9%, P < 0.0003). CONCLUSION: The addition of senna to the bowel preparation protocol with magnesium citrate significantly improves the cleansing outcome.

关键词： Colonoscopy Bowel preparation Senna Magnesium citrate Polyp

Neuropsychological alterations in hepatitis C infection:The role of inflammation

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World Journal of Gastroenterology 2011年第29期17卷 3369-3374页

作者： Marco Senzolo Sami Schiff Cristina Maria D’Aloiso Chiara Crivellin evangelos Cholongitas Patrizia Burra Sara Montagnese Multivisceral Transplant Unit Department of Surgical and Gastroenterological SciencesUniversity Hospital of Padua35128 PaduaItaly Department of Clinical and Experimental Medicine University Hospital of Padua35128 PaduaItaly The Royal Free Sheila Sherlock Liver Centre and Department of Surgery UCL and Royal Free HospitalPond StreetLondon NW3 2QGUnited Kindom

About 50% of patients with hepatitis C virus(HCV)infection complain of neuropsychiatric symptoms,"brain fog",weakness,fatigue,and exhibit some degree of quality of life impairment,irrespective of the severity of liver *** the first observation of HCV-related cognitive deficits,10 studies have been published that have evaluated neuropsychiatric performance in patients with HCV infection and different degrees of hepatic ***,these have often included patients with cirrhosis,patients who had acquired the infection through previous intravenous drug misuse,who had a history of relatively recent treatment with interferon,or were on psychoactive *** addition,different neuropsychological batteries and tests that explored different cognitive domains were used,which makes the results of the studies difficult to ***,limited information is available on the pathogenesis of HCV-related cognitive *** and/or systemic inflammation may be important players but their potential role has not been substantiated by experimental *** present review outlines the available evidence of the presence of cognitive impairment in patients with HCV infection,with a focus on the potential relationship with cerebral and/or systemic inflammation.

关键词： Cognitive alterations Hepatitis C virus Inflammation

Practical approaches to effective management of intestinal radiation injury:Benefit of resectional surgery

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World Journal of Gastroenterology 2011年第35期17卷 4013-4016页

作者： Nikolaos Perrakis evangelos Athanassiou Dimitra Vamvakopoulou Maria Kyriazi Haris Kappos Nikolaos C Vamvakopoulos Iakovos Nomikos Department of Surgery Metaxa Cancer Memorial HospitalPiraeus 11522Greece Department of Surgery University of Thessalia Medical SchoolLarissa 41110Greece Department of Biology and Genetics University of Thessalia Medical SchoolLarissa 41110Greece

AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative ***:During a 7-year period we operated on 17 cases (5 male,12 female) admitted to our surgical department with intestinal radiation injury (IRI).They were originally treated for a pelvic malignancy by surgical resection followed by postoperative *** follow-up,they developed radiation enteritis requiring surgical treatment due to failure of conservative ***:IRI was located in the terminal ileum in 12 patients,in the rectum in 2 patients,in the descending colon in 2 patients,and in the cecum in one *** patients had resection of the affected region(s).There were no postoperative deaths,while 3 cases presented with postoperative complications (17.7%).All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range,6-96 mo).CONCLUSION:We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.

关键词： Pelvic neoplasms Bowel Radiation injuries Surgery

MELD vs Child-Pugh and creatinine-modified Child-Pugh score for Dredicting survival in patients with decompensated cirrhosis

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World Journal of Gastroenterology 2005年第20期11卷 3099-3104页

作者： George V. Papatheodoridis evangelos Cholongitas Eleni Dimitriadou Giota Touloumi Vassilios Sevastianos Athanasios J. Archimandritis 2nd Department of Internal Medicine National University of Athens Medical School Hippokration General Hospital Athens Greece Department of Epidemiology National University of Athens Medical School Athens Greece

AIM: Model of End-stage Liver Disease (MELD) score has recently gained wide acceptance over the old Child-Pugh score in predicting survival in patients with decompensated cirrhosis, although it is more sophisticated. We compared the predictive values of MELD, Child-Pugh and creatinine modified Child-Pugh scores in decompensated cirrhosis. METHODS: A cohort of 102 patients with decompensated cirrhosis followed-up for a median of 6 mo was *** types of modified Child-Pugh scores estimated by adding 0-4 points to the original score using creatinine levels as a sixth categorical variable were ***: The areas under the receiver operating characteristic curves did not differ significantly among the four scores, but none had excellent diagnostic accuracy (areas:0.71-0.79). Child-Pugh score appeared to be the worst, while the accuracy of MELD was almost identical with that of modified Child-Pugh in predicting short-term and slightly better in predicting medium-term survival. In Cox regression analysis, all four scores were significantly associated with survival, while MELD and creatinine-modified Child-Pugh scores had better predictive values (c-statistics: 0.73 and 0.69-0.70) than Child-Pugh score (c-statistics: 0.65). Adjustment for gamma-glutamate transpeptidase levels increased the predictive values of all systems (c-statistics: 0.77-0.81). Analysis of the expected and observed survival curves in patients subgroups according to their prognosis showed that all models fit the data reasonably well with MELD probably discriminating better the subgroups with worse prognosis. CONCLUSION: MELD compared to the old Child-Pugh and particularly to creatinine-modified Child-Pugh scores does not appear to offer a clear advantage in predicting survival in patients with decompensated cirrhosis in daily clinical practice.

关键词： Child-Pugh MELD Cirrhosis Decompensated cirrhosis

Virtual endoscopy of the urinary tract

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Asian Journal of Andrology 2006年第1期8卷 31-38页

作者： George C.Kagadis Dimitrios Siablis evangelos N.Liatsikos Theodore Petsas George C. Nikiforidis Department of Medical Physics Department of Radiology Department of Urology School of MedicineUniversity of PatrasGR 26500 RionGreece Department of Radiology Department of Medical Physics

Technological breakthroughs have advanced the temporal and spatial resolutions of diagnostic imaging, and 3 dimensional （3-D） reconstruction techniques have been introduced into everyday clinical practice. Virtual endoscopy （VE） is a non-invasive technique that amplifies the perception of cross-sectional images in the 3-D space, providing precise spatial relationships of pathological regions and their surrounding structures. A variety of computer algorithms can be used to generate 3-D images, taking advantage of the information inherent in either spiral computed tomography or magnetic resonance imaging （MRI）. VE images enable endoluminal navigation through hollow organs, thus simulating conventional endoscopy. Several clinical studies have validated the diagnostic utility of virtual cystoscopy, which has high sensitivity and specificity rates in the detection of bladder tumor. Published experience in the virtual exploration of the renal pelvis, ureter and urethra is encouraging but still scarce. VE is a safe, non-invasive method that could be applied in the long-term follow-up of patients with ureteropelvic junction obstruction, urinary bladder tumors and ureteral and/or urethral strictures. Its principal limitations are the inability to provide biopsy tissue specimens for histopathologic examination and the associated ionizing radiation hazards （unless MR/is used）. However, in the case of endoluminal stenosis or obstruction, VE permits virtual endoluminal navigation both cephalad and caudal to the stenotic segment. To conclude, VE provides a less invasive method of evaluating the urinary tract, especially for clinicians who are less familiar with cross-sectional imaging than radiologists. （Asian J Androl 2006 Jan; 8： 31-38）

关键词： computed tomography three-dimensional imaging virtual endoscopy urethral stricture

Glucagon-like peptide-1 receptor agonists in non-alcoholic fatty liver disease: An update

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World Journal of Hepatology 2020年第8期12卷 493-505页

作者： Areti Sofogianni Athanasios Filippidis Lampros Chrysavgis Konstantinos Tziomalos evangelos Cholongitas First Propedeutic Department of Internal Medicine Medical SchoolAristotle University of ThessalonikiAHEPA HospitalThessaloniki 54636Greece First Department of Internal Medicine Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthens 11527Greece

Non-alcoholic fatty liver disease(NAFLD)is the predominant cause of chronic liver disease *** progresses in some cases to non-alcoholic steatohepatitis(NASH),which is characterized,in addition to liver fat deposition,by hepatocyte ballooning,inflammation and liver fibrosis,and in some cases may lead to hepatocellular *** prevalence increases along with the rising incidence of type 2 diabetes mellitus(T2DM).Currently,lifestyle interventions and weight loss are used as the major therapeutic strategy in the vast majority of patients with ***-like peptide-1 receptor agonists(GLP-1RAs)are used in the management of T2DM and do not have major side effects like *** patients with NAFLD,the GLP-1 receptor production is ***,several animal and human studies have emphasized the role of GLP-1RAs in ameliorating liver fat accumulation,alleviating the inflammatory environment and preventing NAFLD progression to *** this review,we summarize the updated literature data on the beneficial effects of GLP-1RAs in NAFLD/***,as GLP-1RAs seem to be an attractive therapeutic option for T2DM patients with concomitant NAFLD,we discuss whether GLP-1RAs should represent the first line pharmacotherapy for these patients.

关键词： Glucagon-like peptide-1 receptor agonists Non-alcoholic fatty liver disease Type 2 diabetes mellitus Clinical studies Fatty liver Animal studies

Depression in military medicine cadets: a cross-sectional study

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Military Medical Research 2015年第4期3卷 207-212页

作者： Dimitrios Nasioudis Leonidas Palaiodimos Matthaios Dagiasis Angeliki Katsarou evangelos Ntouros Department of Gynaecology 401 Army General Hospital Department of Medicine Jacobi Medical Center/Albert Einstein College of Medicine Naval Hospital of Athens 251 Hellenic Air Force Hospital Hellenic Military School of Combat Support Officers (SSAS)

Background: Military medicine cadets undergo strenuous military training alongside demanding medical studies. This stressful and complex educational environment can lead to the emergence of depressive symptoms. We investigated the prevalence of depressive symptoms in a cohort of military medicine ***: We conducted a descriptive questionnaire-based cross-sectional study among Greek military medicine cadets in the undergraduate program of the Hellenic Military School of Combat Support Officers. The Greek translation of the Zung self-rating depression scale questionnaire was used to screen for the presence of depressive symptoms. In addition, demographic, academic and dietary information was collected. The Shapiro-Wilk test of normality, Pearson correlation test, Chi-square test, t-test and Mann Whitney U test were employed for statistical ***: We enrolled 55 female and 91 male military medicine cadets with a mean age of 19.84 years(SD=0.99). The mean Zung crude score was 43.32(SD=4.55): 42.8(SD=4.43) for female cadets and 43.64(SD=4.6) for male cadets. Cadets were further subdivided into low and high risk groups for the presence of depressive symptoms. We identified 57(39%) cadets with a total Zung crude score of 45 or above: 21 females and 36 males. Statistical analysis did not reveal any significant differences between the two groups based on gender, year of training, academic performance, alcohol consumption, smoking status, vitamin supplementation, dietary habits or ***: We report a high prevalence of depressive symptoms in a cohort of military medicine cadets that underscores the need for effective screening and appropriate and timely interventions. We did not identify any related risk factors. Military medicine cadets are exposed to a challenging military and medical training environment, and thus represent a group at risk for development of depression.

关键词： Depression Military medicine Medical students Medical education Military training