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Surgical dilemmas in the management of colorectal liver metastases: the role of timing

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World Journal of Gastroenterology 2016年第21期22卷 4963-4965页

作者： Dimitrios Dimitroulis gregory kouraklis Second Department of Surgery University of Athens Medical SchoolAthens GreeceLaiko Hospital11527 AthensGreece

Colorectal cancer(CRC) is an emerging health problem in the Western World both for its raising tendency as well as for its metastatic potential. Almost half of the patients with CRC will develop liver metastases during the course of their disease. The liver surgeon dealing with colorectal liver metastases faces several surgical dilemmas especially in the setting of the timing of operation. Synchronous resectable metastases should be treated prior or after induction chemotherapy? Furthermore in the case of synchronous colorectal liver metastases which organ should we first deal with, the liver or the colon? All these questions are set in the editorial and impulse for further investigation is put focusing on multidisciplinary approach and individualization of treatment modalities.

关键词： Colorectal cancer Chemotherapy Timing of surgery Colorectal liver metastases Liver first procedure Multidisciplinary approach Individualized treatment strategies

Platelet-activating factor in liver injury: A relational scope

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World Journal of Gastroenterology 2006年第23期12卷 3695-3706页

作者： Nikolaos P Karidis gregory kouraklis Stamatios E Theocharis Department of Forensic Medicine and Toxicology University of Athens Medical SchoolAthensGreece Second Department of Propaedeutic SurgeryUniversity of Athens Medical SchoolAthensGreece Second Department of Propaedeutic Surgery University of Athens Medical SchoolAthensGreece Department of Forensic Medicine and Toxicology University of Athens Medical SchoolAthensGreece

The hepatocyte, the main cellular component of the liver, exhibits variable susceptibility to different types of injury induced by endogenous or exogenous factors. Hepatocellular dysfunction or death and regeneration are dependent upon the complicated interactions between numerous biologically active molecules. Platelet- activating factor （PAF） seems to play a pivotal role as the key mediator of liver injury in the clinical and experimental setting, as implied by the beneficial effects of its receptor antagonists. A comprehensive up-to-date overview of the specific functional and regulatory properties of PAF in conditions associated with liver injury is attempted in this review.

关键词： PAF PAF-R antagonists Liver Injury Regeneration

Current treatment for colorectal liver metastases

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World Journal of Gastroenterology 2011年第36期17卷 4067-4075页

作者： Evangelos P Misiakos Nikolaos P Karidis gregory kouraklis Third Department of Surgery Medical SchoolUniversity of AthensAttikon University HospitalAthens 12462Greece Second Propedeutic Department of Surgery Medical SchoolUniversity of AthensGeneral Hospital LaikoAthens 11527Greece

Surgical resection offers the best opportunity for survival in patients with colorectal cancer metastatic to the liver,with five-year survival rates up to 58% in selected ***,only a minority are resectable at the time of *** research in this field aims at increasing the percentage of patients eligible for resection,refining the indications and contraindications for surgery,and improving overall *** use of surgical innovations,such as staged resection,portal vein embolization,and repeat resection has allowed higher resection rates in patients with bilobar *** use of neoadjuvant chemotherapy allows up to 38% of patients previously considered unresectable to be significantly downstaged and eligible for hepatic *** techniques have gained wide acceptance as an adjunct to surgical resection and in the management of patients who are not surgical *** management of colorectal liver metastases requires a multidisciplinary approach,which should be individualized in each case.

关键词： Colorectal liver metastases Multidisciplinary treatment

Role of surgery in colorectal liver metastases:Too early or too late?

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World Journal of Gastroenterology 2010年第28期16卷 3484-3490页

作者： Dimitrios Dimitroulis Nikolaos Nikiteas Theodore Troupis Dimitrios Patsouras Panayiotis Skandalakis gregory kouraklis Second Department of Propaedeutic Surgery School of MedicineUniversity of Athens"LAIKON" University Hospital14 Ag.Thoma Street11527 AthensGreece Department of Surgery and Transplantation 4 Sakelariou Street17455 AlimosAthensGreece Department of Anatomy School of MedicineUniversity of Athens75 Mikras Asias Street11527 AthensGreece

As colorectal cancer and colorectal liver metastases become a serious public health problem,new treatment modalities are needed in order to achieve better results. In the last decade there has been very important progress in oncology,with new and more effective chemotherapeutic agents administered alone or in combination improving the resectability rate in up to 40%of patients with colorectal liver *** in interventional radiology,in particular,with the use of portal vein embolization and radiofrequency thermal ablation are new strategies allowing major liver resections and treatment of small liver metastases or early ***,however,remains the gold standard strategy with intention to *** this review article we will describe the advanced role of surgery in the multidisciplinary approach to colorectal liver metastases,and the clinical problems the liver surgeon has to deal with,such as theresectability of the metastases,the presence of bilobar liver lesions and extrahepatic disease,the impact of chemotherapy in already resectable liver metastases,the problem of vanishing metastases after chemotherapy and the dilemma of staged or combined liver and colon operations and which organ first in the clinical scenario of synchronous colorectal liver metastases.

关键词： Metastases Liver metastases Colorectal cancer Surgery

Barrett's esophagus with high-grade dysplasia:Focus on current treatment options

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World Journal of Gastroenterology 2011年第37期17卷 4174-4183页

作者： Leonidas Lekakos Nikolaos P Karidis Dimitrios Dimitroulis Christos Tsigris gregory kouraklis Nikolaos Nikiteas Second Propedeutic Department of Surgery Medical SchoolUniversity of AthensGeneral Hospital LaikoAthens 11527Greece Christos Tsigris First Department of SurgeryMedical SchoolUniversity of AthensGeneral Hospital LaikoAthens 11527Greece

High-grade dysplasia(HGD) in Barrett's esophagus(BE) is the critical step before invasive esophageal *** its natural history remains unclear,an aggressive therapeutic approach is usually *** represents the only treatment able to reliably eradicate the neoplastic *** healthy patients with reasonable life expectancy,vagal-sparing esophagectomy,with associated low mortality and low early and late postoperative morbidity,is considered the treatment of choice for BE with *** unfit for surgery should be managed in a less aggressive manner,using endoscopic ablation or endoscopic mucosal resection of the entire BE segment,followed by lifelong *** eligible for surgery who present with a long BE segment,multifocal dysplastic lesions,severe reflux symptoms,a large fixed hiatal hernia or dysphagia comprise a challenging group with regard to the appropriate treatment,either surgical or endoscopic.

关键词： Barrett's esophagus High-grade dysplasia Endoscopic ablation Endoscopic excision Surgical treatment

Co-existence of hepatocellular adenoma and focal nodular hyperplasia in a young female

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World Journal of Hepatology 2012年第11期4卷 314-318页

作者： Dimitrios Dimitroulis Panagiotis Lainas Petros Chara-lampoudis Theodore Karatzas Nikolaos Karidis gregory kouraklis Ioanna Delladetsima Nikolaos Karidis gregory kouraklis Stratigoula Sakellariou 2nd Department of General Surgery Laiko Hospital University of Athens Medical School 11527 Athens Greece Department of Pathology Laiko Hospital University of Athens Medical School 11527 Athens Greece

Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are both benign hepatocellular lesions, presenting mainly in women of childbearing age in non-cirrhotic, non-fibrotic livers. Simultaneous occurrence of these two lesions is extremely rare. We herein report a case of a young female without any predisposing risk factors who presented to our emergency department complaining of acute abdominal pain. Imaging studies revealed a 6 cm lesion in the right hepatic lobe and a 2.5 cm lesion in the left hepatic lobe, respectively. In view of the patient’s symptoms and lack of a confirmed diagnosis based on imaging, we performed a bisegmentectomy V-VI and a wedge resection of the lesion in segment III by laparotomy. Postoperative course was uneventful and the patient was discharged on the fourth postoperative day. The pathology report demonstrated an HA in segments V-VI and FNH in segment III, respectively. Six months later, the patient remains asymptomatic with normal liver function tests, ultrasound and magnetic resonance imaging follow-up. To our best knowledge, this is the first case to describe simultaneous occurrence of HA and FNH without the presence of any known risk factors for these entities. The uncertainty in diagnosis and acuteness of presenting symptoms were established criteria for prompt surgical intervention.

关键词： Liver surgery Liver disease Hepatocellular adenoma Focal nodular hyperplasia Benign hepatic tumor

Indications,limitations and maneuvers to enable extended hepatectomy:Current trends

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World Journal of Gastroenterology 2014年第24期20卷 7887-7893页

作者： Dimitrios Dimitroulis Petros Tsaparas Serena Valsami Dimitrios Mantas Eleftherios Spartalis Charalampos Markakis gregory kouraklis Second Department of Propedeutic Surgery Athens University Medical School"Laiko" Hospital11527 AthensGreece Blood Transfusion Department Athens University Medical SchoolAreteion Hospital11527 AthensGreece

The liver is a solid organ with a wide variety of primary benign or malignant tumors as well as metastatic *** resection of these tumors remains the only curative *** limitations,however,do not allow the performance of these *** review evaluates the indications and limitations regarding these extended hepatic resections,as well as describing all the manipulations that increase the candidates for such operations.A thorough review of the literature was performed in order to define indications for extended hepatectomy,as well as to present all methods that contribute to increasing the volume of the future remnant *** role of portal vein ligation,portal vein embolization,two-stage hepatectomy,and in situ liver transection are evaluated in the setting of indications and *** hepatectomies are a necessity due to oncological *** methods developed in order to increase the volume of the remnant liver are safe and *** situ liver transection is a novel and revolutionary two-step procedure for extended hepatic *** clinical studies are required to estimate long-term results and the oncological basis of this technique.

关键词： Extended hepatectomy Portal vein ligation Remnant liver volume

Small intestine diverticula:Is there anything new?

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World Journal of Gastrointestinal Surgery 2011年第4期3卷 49-53页

作者： Dimitris Mantas Stylianos Kykalos Dimitris Patsouras gregory kouraklis 2nd Department of Propedeutic Surgery Medical School of Athens UniversityLaiko General Hospital

AIM:To globally approach the clinical entity of small bowel diverticulosis and, at the same time, set out the treatment options. METHODS: We analysed 77 cases of diverticula located in the duodenum, jejunum and ileum that were treated in our department, evaluating the symptoms, diagnostic approach and offered treatment. RESULTS: Almost half of the diverticula (46.7%) were incidentally discovered and Meckel's diverticula represented the majority (43%) that were actually the only true diverticula. A high complication rate (53%) which included inflammation with or without perforation (22%), bleeding (10%) or obstructive ileus (12%) due to small bowel diverticulosis was reported. The preoperative diagnosis was often impossible (44% of complicated cases). CONCLUSION: Although small bowel diverticulosis has a low incidence, it should be in the clinician's mind in order to avoid misdiagnosis.

关键词： Diverticulosis Diverticulitis Duodenum Small bowel

From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world

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World Journal of Gastroenterology 2017年第29期23卷 5282-5294页

作者： Dimitrios Dimitroulis Christos Damaskos Serena Valsami Spyridon Davakis Nikolaos Garmpis Eleftherios Spartalis Antonios Athanasiou Demetrios Moris Stratigoula Sakellariou Stylianos Kykalos Gerasimos Tsourouflis Anna Garmpi Ioanna Delladetsima Konstantinos Kontzoglou gregory kouraklis Second Department of Propedeutic Surgery Laiko General Hospital Medical School National and Kapodistrian University of Athens Blood Transfusion Department Aretaieion Hospital Medical School National and Kapodistrian Athens University First Department of Surgery Laiko General Hospital Medical School National and Kapodistrian University of Athens N.S. Christeas Laboratory of Experimental Surgery and Surgical Research Medical School National and Kapodistrian University of Athens Department of Surgery Mercy University Hospital Lerner Research Institute Cleveland Clinic Foundation First Department of Pathology Medical School National and Kapodistrian University of Athens Internal Medicine Department Laiko General Hospital University of Athens Medical School

Hepatocellular carcinoma(HCC) is the most frequent primary liver malignancy and the third cause of cancer-related death in the Western Countries. The well-established causes of HCC are chronic liver infections such as hepatitis B virus or chronic hepatitis C virus, nonalcoholic fatty liver disease, consumption of aflatoxins and tobacco smocking. Clinical presentation varies widely; patients can be asymptomatic while symptomatology extends from right upper abdominal quadrant paint and weight loss to obstructive jaundice and lethargy. Imaging is the first key and one of the most important aspects at all stages of diagnosis, therapy and follow-up of patients with HCC. The Barcelona Clinic Liver Cancer Staging System remains the most widely classification system used for HCC management guidelines. Up until now, HCC remains a challenge to early diagnose, and treat effectively; treating management is focused on hepatic resection, orthotopic liver transplantation, ablative therapies, chemoembolization and systemic therapies with cytotocix drugs, and targeted agents. This review article describes the current evidence on epidemiology, symptomatology, diagnosis and treatment of hepatocellular carcinoma.

关键词： Hepatocellular Cancer Epidemiology Treatment Diagnosis Staging Transplantation