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Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

World Journal of Gastroenterology 2008年第22期14卷 3583-3586页

作者： Haridimos Markogiannakis Manousos Konstadoulakis Dimitrios Tzertzemelis Pantelis Antonakis ilias gomatos Constantinos Bramis Andreas Manouras 1st Department of Propaedeutic Surgery Hippokration Hospital Athens Medical School University of Athens Vasilissis Sofias 114 Avenue Athens 11527 Greece

Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigationof even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.

关键词： Heart-lung transplantation Acute diverticulitis Colon perforation Subclinical peritonitis

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Molecular markers(PECAM-1,ICAM-3,HLA-DR)determine prognosis in primary non-Hodgkin's gastric lymphoma patients

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World Journal of Gastroenterology 2006年第12期12卷 1924-1932页

作者： Alexander Darom ilias P gomatos Emmanuel Leandros Emmu Chatzigianni Dimitris Panousopoulos Manousos M Konstadoulakis George Androulakis Laboratory of Surgical Research First Department of Propaedeutic SurgeryAthens Medical SchoolHippokration Hospital of Athens114 Q.Sofia Ave11527 AthensGreece

AIM： To investigate the prognostic significance of PECAM-1, ICAM-3 and HLA-DR antigens in patients with primary non-Hodgkin＇s gastric lymphoma. METHODS： We immunohistochemically studied PECAM-1, ICAM-3 and HLA-DR antigen expression in 36 B-cell MALT-type primary gastric lymphoma patients. Ten non-malignant and ten healthy gastric tissue specimens were used as controls. Clinicopathological and survival data were correlated with the staining results. RESULTS： HLA-DR antigen expression was detected in 33 gastric lymphoma patients （91.7%） and 6 nonmalignant patients （54.5%）. PECAM-1 stained tumor cells of 10 patients （27.8%）, endothelial cells of 9 patients （25%） and inflammatory infiltrate of 4 patients （40%） with benign gastric disease. ICAM-3 expression was observed on the tumor cells of 17 patients （47.2%）, while 5 non-malignant patients （50%） were stained positive as well. None of the healthy controls was stained for any of the genes studied. In the multivariate analysis, HLA-DR antigen and PECAM-1 were proved to be statistically significant independent prognostic factors associated with a favourable and an unfavourable prognosis respectively （P= 0.009 and P= 0.003）. In the univariate analysis, PECAM-1（＋）/ICAM-3（-） and HLA-DR（-）/ICAM-3（-） patients exhibited a significantly decreased overall survival compared to those with the exactly opposite gene expression patterns （P=0.0041 and P= 0.0091, respectively）. Those patients who were HLA-DR（＋）/ICAM-3（＋）/PECAM-I（-）（n = 8） had a significantly higher survival rate compared to the rest of the group （n = 24）（P= 0.0289）. CONCLUSION： PECAM-1, ICAM-3 and HLA-DR are representative markers of tumor expansion potential and host immune surveillance respectively. Their combined use may help us to identify high-risk patients who could benefit from more aggressive therapeutic protocols.

关键词： PECAM-1 ICAM-3 HLA-DR Non-Hodgkin's gastric lymphoma Prognosis

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Liver histology in ICU patients dying from sepsis:A clinico-pathological study

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World Journal of Gastroenterology 2008年第9期14卷 1389-1393页

作者： John Koskinas ilias P gomatos Dina G Tiniakos Nikolaos Memos Maria Boutsikou Aspasia Garatzioti Athanasios Archimandritis Alexander Betrosian 2nd Department of Internal Medicine Athens Medical SchoolAthens 11527Greece Laboratory of Surgical Research 1st Department of Propaedeutic SurgeryAthens Medical SchoolAthens 11527Greece Laboratory of Histology and Embryology Athens Medical School Athens 11527Greece Laboratory of Surgical Research 1st Department of Propaedeutic Surgery Athens Medical School Athens 11527Greece Intensive Care Unit Hippocration HospitalAthens 11527Greece

AIM:To determine end-stage pathologic changes in the liver of septic patients dying in the intensive care unit. METHODS: Needle liver biopsies obtained immediately after death from 15 consecutive patients with sepsis and no underlying liver disease were subjected to routine histological examination. Liver function tests and clinical monitoring measurements were also recorded. RESULTS: Liver biochemistries were increased in the majority of patients before death. Histology of liver bi- opsy specimens showed portal inflammation in 73.3%, centrilobular necrosis in 80%, lobular inflammation in 66.7%, hepatocellular apoptosis in 66.6% and cholan- gitis/cholangiolitis in 20% of patients. Mixed hepatitic/ cholestatic type of liver injury was observed in 6/15 (40%) patients and hepatitc in 9/15 (60%). Steatosis was ob- served in 11/15 (73.3%) patients affecting 5%-80% of liver parenchyma. Among the histological features, the presence of portal inflammation in liver biopsy was as- sociated with increased hospitalization in the ICU prior death (P = 0.026). CONCLUSION: Features of hepatitis and steatosis arethe main histological findings in the liver in the majority of patients dying from sepsis.

关键词： Severe sepsis Liver Biopsy Histology

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Prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy:A systematic review and metaanalysis

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World Journal of Gastroenterology 2015年第8期21卷 2510-2521页

作者： Yi-Chao Wang Peter Szatmary Jing-Qiang Zhu Jun-Jie Xiong Wei Huang ilias gomatos Quentin M Nunes Robert Sutton Xu-Bao Liu Department of Thyroid and Breast Surgery West China Hospital Sichuan University NIHR Liverpool Pancreas Biomedical Research Unit Royal Liverpool University Hospital University of Liverpool Department of Pancreatic Surgery West China Hospital Sichuan University

AIM:To conduct a meta-analysis comparing outcomes after pancreaticoduodenectomy(PD)with or without prophylactic ***:Relevant comparative randomized and nonrandomized studies were systemically searched based on specific inclusion and exclusion *** outcomes were compared between patients with and those without routine *** odds ratios(OR)with 95%CI were calculated using either fixed effects or random effects ***:One randomized controlled trial and four non-randomized comparative studies recruiting 1728patients were *** without prophylactic drainage after PD had significantly higher mortality(OR=2.32,95%CI:1.11-4.85;P=0.02),despite the fact that they were associated with fewer overall complications(OR=0.62,95%CI:0.48-0.82;P=0.00),major complications(OR=0.75,95%CI:0.60-0.93;P=0.01)and readmissions(OR=0.77,95%CI:0.60-0.98;P=0.04).There were no significant differences in the rates of pancreatic fistula,intraabdominal abscesses,postpancreatectomy hemorrhage,biliary fistula,delayed gastric emptying,reoperation or radiologic-guided drains between the two ***:Indiscriminate abandonment of intraabdominal drainage following PD is associated with greater mortality,but lower complication *** randomized trials should compare routine vs selective drainage.

关键词： Pancreaticoduodenectomy Drain Metaanalysis Morbidi

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Meta-analysis of subtotal stomach-preserving pancreaticoduodenectomy vs pylorus preserving pancreaticoduodenectomy

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World Journal of Gastroenterology 2015年第20期21卷 6361-6373页

作者： Wei Huang Jun-Jie Xiong Mei-Hua Wan Peter Szatmary Shameena Bharucha ilias gomatos Quentin M Nunes Qing Xia Robert Sutton Xu-Bao Liu Sichuan Provincial Pancreatitis Center Department of Integrated Traditional Chinese Medicine and Western MedicineWest China HospitalSichuan University Department of Pancreatic Surgery West China HospitalSichuan University NIHR Liverpool Pancreas Biomedical Research Unit Royal Liverpool University Hospital

AIM: To investigate the differences in outcome following pylorus preserving pancreaticoduodenectomy(PPPD) and subtotal stomach-preserving pancreaticoduodenectomy(SSPPD).METHODS: Major databases including Pub Med(Medline), EMBASE and Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL) in The Cochrane Library were searched for comparative studies between patients with PPPD and SSPPD published between January 1978 and July 2014. Studies were selected based on specific inclusion and exclusion criteria. The primary outcome was delayed gastric emptying(DGE). Secondary outcomes included operation time, intraoperative blood loss, pancreatic fistula, postoperative hemorrhage, intraabdominal abscess, wound infection, time to starting liquid diet, time to starting solid diet, period of nasogastric intubation, reinsertion of nasogastric tube, mortality and hospital stay. The pooled odds ratios(OR) or weighted mean difference(WMD) with 95% confidence intervals(95%CI) were calculated using either a fixed-effects or random-effects model. RESULTS: Eight comparative studies recruiting 650 patients were analyzed, which include two RCTs, one non-randomized prospective and 5 retrospective trial designs. Patients undergoing SSPPD experienced significantly lower rates of DGE(OR = 2.75; 95%CI: 1.75-4.30, P < 0.00001) and a shorter period of nasogastric intubation(OR = 2.68; 95%CI: 0.77-4.58,P < 0.00001), with a tendency towards shorter time to liquid(WMD = 2.97, 95%CI:-0.46-7.83; P = 0.09) and solid diets(WMD = 3.69, 95%CI:-0.46-7.83; P = 0.08) as well as shorter inpatient stay(WMD = 3.92, 95%CI:-0.37-8.22; P = 0.07), although these latter three did not reach statistical significance. PPPD, however, was associated with less intraoperative blood loss than SSPPD [WMD =-217.70, 95%CI:-429.77-(-5.63); P = 0.04]. There were no differences in other parameters between the two approaches, including operative time(WMD =-5.30, 95%CI:-43.44-32.84; P = 0.79

关键词： Pancreaticoduodenectomy Pylorus preservingSubtotal stomach preserving pancreaticoduodenectomy Delayed gastric emptying Pancreatic surgery Metaanalysis

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