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Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

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World Journal of Gastroenterology 2009年第3期15卷 339-343页

作者： Nikolaos Arkadopoulos Vaia Stafyla Athanasios Marinis Vassilios Koutoulidis Kassiani Theodoraki Theodosios Theodosopoulos ioannis vassiliou Nikolaos Dafnios Georgios Fragulidis Vassilios Smyrniotis Second Department of Surgery School of MedicineUniversity of AthensAretaieion University Hospital76 Vassilisis Sofia's Ave11528 AthensGreece First Department of Radiology School of MedicineUniversity of Athens Aretaieion University Hospital76 Vassilisis Sofi a's Ave11528 AthensGreece First Department of Anesthesiology School of MedicineUniversity of AthensAretaieion University Hospital76 Vassilisis Sofi a's Ave11528 AthensGreece

AIM:To test whether clamping during liver surgery predisposes to hepatic vein ***:We performed a retrospective analysis of 210 patients who underwent liver resection with simultaneous inflow and outflow ***,flow in the hepatic veins was assessed by Doppler ultrasonography during the reperfusion ***,patency of the hepatic veins was assessed by contrast-enhanced CT angiography,when necessary after 3-6 mo follow ***:Twelve patients(5.7%) developed intraoperative liver remnant ***,intraoperative ultrasonography did not reveal evidence of hepatic vein *** three of these patients a kinking of the common trunk of the middle and left hepatic veins hindering outflow was recognized and was managed successfully bysuturing the liver remnant to the *** three patients(10.9%) who developed signs of mild outflow obstruction postoperatively,had no evidence of thrombi in the hepatic veins or flow disturbances on ultrasonography and contrast-enhanced CT angiography,while *** term assessment of the patency of the hepatic veins over a 3-6 mo follow-up period did not reveal thrombi formation or clinical manifestations of out flow ***:Extrahepatic dissection and clamping of the hepatic veins does not predispose to clinically important thrombosis.

关键词： CT-angiography Doppler ultrasound Liver resection Pringle maneuver Radiofrequency Selective hepatic vascular exclusion

Surgical approaches of resectable synchronous colorectal liver metastases:Timing considerations

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World Journal of Gastroenterology 2007年第9期13卷 1431-1434页

作者： ioannis vassiliou Nick Arkadopoulos Theodosios Theodosopoulos Georgios Fragulidis Athanasios Marinis Agathi Kondi-Paphiti Lazaros Samanides Andreas Polydorou Constantinos Gennatas Dionysios Voros Vassilios Smyrniotis 2nd Department of Surgery Aretaieion HospitalUniversity of AthensSchool of Medicine AthensGreece Department of Pathology Aretaieion Hospital University of Athens School of Medicine Athens Greece Department of Oncology Aretaieion Hospital University of Athens School of Medicine AthensGreece

AIM: To compare the safety and efficacy of simultaneous versus two stage resection of primary colorectal tumors and liver metastases. METHODS: From January 1996 to May 2004, 103 colorectal tumor patients presented with synchronous liver metastases. Twenty five underwent simultaneous colorectal and liver surgery and 78 underwent liver surgery 1-3 mo after primary colorectal tumor resection. Data were retrospectively analyzed to assess and compare the morbidity and mortality between the surgical strategies. The two groups were comparable regarding the age and sex distribution, the types of liver resection and stage of primary tumors, as well as the number and size of liver metastases. RESULTS: In two-stage procedures more transfusions were required (4 ± 1.5 vs 2 ± 1.8, pRBCs, P < 0.05). Chest infection was increased after the two-stage approach (26% vs 17%, P < 0.05). The two-stage procedure was also associated with longer hospitalization (20 ± 8 vs 12 ± 6 d, P < 0.05). Five year survival in both groups was similar (28% vs 31%). No hospital mortality occurred in our series. CONCLUSION: Synchronous colorectal liver metastases can be safely treated simultaneously with the primary tumor. Liver resection should be prioritized over colon resection. It is advisable that complex liver resections with marginal liver residual volume should be dealt with at a later stage.

关键词： Synchronous colorectal liver metastases Colon resections Liver resections

An ongoing dispute in the management of severe pancreatic fistula:Pancreatospleenectomy or not?

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World Journal of Gastrointestinal Surgery 2010年第11期2卷 381-384页

作者： Dionysios Dellaportas Aliki Tympa Constantinos Nastos Vasiliki Psychogiou Andreas Karakatsanis Andreas Polydorou George Fragulidis ioannis vassiliou Vassilios Smyrniotis Second Department of Surgery Athens Medical SchoolAretaieion Hospital76 Vassilisis Sofias Avenue11528 AthensGreece Fifth Department of Surgery Athens Medical SchoolAretaieion Hospital76 Vassilisis Sofias Avenue11528 AthensGreece

The aim of this manuscript is to review controversies in managing severe pancreatic fistula after pancreatic *** progress in surgical technique and perioperative care has reduced the mortality rate of pancreatic ***,leakage of the pancreatic stump still accounts for the majority of surgical complications after pancreatic *** strategies have been employed in order to manage pancreatic *** high grade pancreatic fistula evokes controversy in relation to the choice of treatment.A Medline search was performed,with regard to conservative treatment options versus completion pancreatectomy for the management of pancreatic fistula grade *** fistula rates remain unchanged with an incidence ranging from 5%-20% and this is considered as the most important cause of postoperative *** authors claim that completion pancreatectomy has probably lost its role in favour of interventional radiology procedures,while others believe that completion pancreatectomy continues to have a place in the management of patients with severe clinical deterioration after pancreatic fistula who do not respond to non-surgical *** is no agreement on the best clinical management of severe pancreatic fistula after pancreatic *** pancreatectomy is reserved for patients not improving with conventional measures.

关键词： Pancreatic fistula Pancreatoduodenectomy Pancreatospleenectomy Completion pancreatectomy Percutaneous drainage

Cardiovascular magnetic resonance: Stressing the future

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World Journal of Cardiology 2019年第8期11卷 195-199页

作者： ioannis Merinopoulos Tharusha Gunawardena Simon C Eccleshall Vassilios S vassiliou Norwich Medical School University of East AngliaNorfolk and Norwich University HospitalNorwich NR4 7UYUnited Kingdom Department of Cardiology Norfolk and Norwich University HospitalNorwich NR4 7UQUnited Kingdom

Non-invasive cardiac stress imaging plays a central role in the assessment of patients with known or suspected coronary artery *** current guidelines suggest estimation of the myocardial ischaemic burden as a criterion for revascularisation on prognostic grounds despite the lack of standardised reporting of the magnitude of ischaemia on various non-invasive imaging *** studies should aim to accurately describe the relationship between myocardial ischaemic burden as assessed by cardiovascular magnetic resonance imaging and mortality.

关键词： Coronary artery disease Myocardial ischaemic burden Non-invasive imaging Cardiac stress Magnetic resonance imaging