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Critical considerations for the management of acute abdomen in transplant patients

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World Journal of Transplantation 2024年第2期14卷 8-12页

作者： Efstathios T Pavlidis ge.rgios katsanos Athanasios Kofinas ge.rgios Tsoulfas Ioannis N Galanis Theodoros E Pavlidis The 2^(nd)Department of Propaedeutic Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece Department of Transplantation Surgery Center for Research and Innovation in Solid Organ TransplantationAristotle University of ThessalonikiSchool of MedicineThessaloniki 54642Greece

The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine ***,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute *** problems in immunocompromised patients may not only include graft-related problems but also nongraft-related *** perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these *** perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic *** in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation *** times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and *** computed tomo-graphy is of utmost importance for early diagnosis and *** recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and *** is necessary to follow evidence-based therapeutic ***,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive s

关键词： Acute abdomen Abdominal emergency surgery Transplantation Immunocompromised patients Immuno-suppression Posttransplantation surgery

Double-layered covered stent for the treatment of malignant oesophageal obstructions: Systematic review and meta-analysis

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World Journal of Gastroenterology 2016年第34期22卷 7841-7850页

作者： Zeiad Hussain Athanasios Diamantopoulos Miltiadis Krokidis Konstantinos katsanos Department of Interventional Radiology Guy’s and St.Thomas’ HospitalsNHS Foundation Trust Department of Interventional Radiology Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation Trust

AIM To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal *** A systematic review and meta-analysis was performed following the PRISMA process. Pub Med(Medline),EMBASE(Excerpta Medical Database),AMED(Allied and Complementary medicine Database),Scopus and online content,were searched for studies reporting on the Ni Ti-S polyurethane-covered double oesophageal stent for the treatment of malignant dysphagia. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. All studies reporting the outcome of palliative management of dysphagia due to histologically confirmed malignant oesophageal obstruction using double-layered covered nitinol stent were included. The level of statistical significance was set at α = *** Six clinical studies comprising 250 patients in total were identified. Pooled technical success of stent insertion was 97.2%(95%CI: 94.8%-98.9%; I2 = 5.8%). Pooled complication rate was 27.6%(95%CI: 20.7%-35.2%; I2 = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was-2.00 [95%CI:-2.29%-(-1.72%); I2 = 87%]. Distal stent migration was documented in 10 out of the 250 cases *** stent migration rate was 4.7%(95%CI: 2.5%-7.7%; I2 = 0%). Finally,tumour overgrowth was reported in 34 out of the 250 cases with pooled rate of tumour overgrowth of 11.2%(95%CI: 3.7%-22.1%; I2 = 82.2%). No funnel plot asymmetry to suggest publication bias(bias = 0.39,P = 0.78). In the sensitivity analysis all results were largely similar between the fixed and random effects *** The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour

关键词： Double-layered covered stent Malignant oesophageal obstructions Dysphagia Double-layered nitinol stent

Pseudopolyps in inflammatory bowel diseases: Have we learned enough?

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World Journal of Gastroenterology 2017年第9期23卷 1541-1551页

作者： Dimitrios S Politis Konstantinos H katsanos Epameinondas V Tsianos Dimitrios K Christodoulou Department of Gastroenterology University Hospital of IoanninaFaculty of MedicineSchool of Health SciencesUniversity of Ioannina45110 IoanninaGreece

Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasiaassociated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.

关键词： Pseudopolyps Inflammatory polyps Post-inflammatory polyps Giant pseudopolyps Ulcerative colitis Inflammatory bowel disease Crohn’s disease Classification Dysplasia-associated mass or lesion

Do we really understand what the immunological disturbances in inflammatory bowel disease mean?

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World Journal of Gastroenterology 2009年第5期15卷 521-525页

作者： Epameinondas V Tsianos Konstantinos katsanos 1st Department of Internal Medicine and Hepato-Gastroenterology Unit Medical School University of Ioannina Ioannina 45110 Greece

The gastrointestinal tract uses a system of tolerance and controlled inflammation to limit the response to dietary or bacteria-derived antigens in the gut. When this complex system breaks down, either by a chemi- cal or pathogenic insult in a genetically predisposed individual the resulting immune response may lead to inflammatory bowel disease. Although the aetio- pathogenesis of inflammatory bowel disease remains unsolved current evidence indicates that defective T-cell apoptosis and impairment of intestinal epithelial barrier function play important roles. In inflammatory bowel disease, it has been reported that activation of macrophages seems to be as important as increased production of the macrophage-derived cytokines such as TNF-α, IL-1 and IL-6. The triggering factor for this cascade is still to be elucidated as to whether it rep- resents an auto-antigen or a hetero-antigen. It has been also demonstrated that a serologic anti-microbial response exists. This response includes antibodies against saccharomyces cerevisiae （ASCA）, E. coli outer membrane porin C （Omp-C）, flagelin （cBirl） and pseu- domonas aeroginosa （I2）. Host response to microbial pathogens includes self-defense mechanisms including defensins, pattern recognition receptors and Toll-like receptors. Neuroimmunomodulation in inflammatory bowel disease （IBD） is another interesting approach with implications on the influence of brain-gut axis on intestinal inflammation and its perpetuation. It isprobable that inflammatory bowel disease represents a heterogenic group of diseases that share similar mechanisms of tissue damage but have different ini- tiating events and immunoregulatory abnormalities. A better understanding of all these events will hope- fully provide new insights into the mechanisms of epithelial responses to microorganisms and ideas for therapies.

关键词： Inflammatory bowel disease Immunologicaldisturbances Serological markers Pathogenesis

Quantifying tissue perfusion after peripheral endovascular procedures:Novel tissue perfusion endpoints to improve outcomes

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World Journal of Cardiology 2021年第9期13卷 381-398页

作者： Nikolaos-Achilleas Arkoudis Konstantinos katsanos Riccardo Inchingolo Ioannis Paraskevopoulos Martin Mariappan Stavros Spiliopoulos 2nd Radiology Department Interventional Radiology UnitAttikon University General HospitalAthens 12461Greece Interventional Radiology Department Patras University HospitalPATRAS 26441Greece Interventional Radiology Unit “F.Miulli”Regional General HospitalAcquaviva delle Fonti 70021Italy Department of Clinical Radiology Interventional Radiology UnitAberdeen Royal InfirmaryNHS GrampianAberdeen AB252ZNUnited Kingdom Department of Clinical Radiology Interventional Radiology UnitAberdeen Royal InfirmaryNHS GrampianAberdeen AB155EYUnited Kingdom 2nd Radiology Department Interventional Radiology UnitSchool of MedicineNational and Kapodistrian University of AthensAthens 12461Greece

Peripheral artery disease(PAD)is a flow-limiting condition caused by narrowing of the peripheral arteries typically due to *** affects almost 200 million people globally with patients either being asymptomatic or presenting with claudication or critical or acute limb ***-affected patients display increased mortality rates,rendering their management *** interventions have proven crucial in PAD treatment and decreasing mortality and have significantly increased over the past ***,for the functional assessment of the outcomes of revascularization procedures for the treatment of PAD,the same tests that have been used over the past decades are still being *** only allow an indirect evaluation,while an objective quantification of limb perfusion is not *** intraarterial angiography only demonstrates post-intervention vessel patency,hence is unable to accurately estimate actual limb perfusion and is incapable of quantifying treatment ***,there is a significant necessity for real-time objectively measurable procedural outcomes of limb perfusion that will allow vascular experts to intraop eratively quantify and assess outcomes,thus optimizing treatment,obviating misinterpretation,and providing significantly improved clinical *** purpose of this review is to familiarize readers with the currently available perfusion-assessment methods and to evaluate possible prospects.

关键词： Peripheral arterial disease Critical limb ischemia Endovascular treatment Peripheral angioplasty Tissue perfusion Quantification

Surgical chest complications after liver transplantation

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World Journal of Transplantation 2022年第11期12卷 359-364页

作者： Apostolos C Agrafiotis Konstantina-Eleni Karakasi Mathilde Poras Stavros Neiros Stella Vasileiadou ge.rgios katsanos Department of Thoracic Surgery Saint-Pierre University HospitalUniversitéLibre de BruxellesBruxelles 1000Belgium Department of Transplantation Medical SchoolAristotle University of ThessalonikiHippokration General HospitalThessaloniki 54642Greece Department of Abdominal Surgery Saint-Pierre University HospitalUniversitéLibre de BruxellesBruxelles 1000Belgium

Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest ***,chronic liver disease affects pulmonary function before and after liver transplantation resulting in a considerable percentage of patients presenting with morbidity related to chest *** review aims to identify the potential chest complications of surgical interest during or after liver *** of surgical interest are defined as those conditions that necessitate an invasive procedure(such as thoracocentesis or a chest tube placement)in the chest or a surgical intervention performed by a thoracic *** complications will be classified as perioperative and postoperative;the latter will be categorized as early and *** thoracocentesis or a chest tube placement is usually sufficient when invasive measures are deemed necessary,in some patients,thoracic surgical interventions are warranted.A high index of suspicion is needed to recognize and treat these conditions promptly.A close collaboration between abdominal surgeons,intensive care unit physicians and thoracic surgeons is of paramount importance.

关键词： Surgical chest complications Liver transplantation Chest related morbidity Multidisciplinary treatment Surgery

Role of genetics in the diagnosis and prognosis of Crohn's disease

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World Journal of Gastroenterology 2012年第2期18卷 105-118页

作者： Epameinondas V Tsianos Konstantinos H katsanos Vasileios E Tsianos 1st Division of Internal Medicine and Hepato-Gastroenterology Unit Department of MedicineMedical SchoolUniversity of IoanninaLeoforos Stavrou NiarxouPO Box 118645110 IoanninaGreece

Considering epidemiological,genetic and immunological data,we can conclude that the inflammatory bowel diseases are heterogeneous disorders of multifactorial etiology in which hereditability and environment interact to produce the *** is probable that patients have a genetic predisposition for the development of the disease coupled with disturbances in *** genes have been so far related to the diagnosis of Crohn's *** genes are related to innate pattern recognition receptors,to epithelial barrier homeostasis and maintenance of epithelial barrier integrity,to autophagy and to lymphocyte *** far,the most strong and replicated associations with Crohn's disease have been done with NOD2,IL23R and ATG16L1 *** genes have so far been implicated in prognosis of Crohn's disease and many attempts have been made to classify genetic profiles in Crohn's ***15 seems not only a susceptibility gene,but also a disease-modifier gene for Crohn's *** our understanding on Crohn's disease genetics is important but when combining genetic data with functional data the outcome could be of major importance to clinicians.

关键词： Crohn's genetics Polymorphism Diagnosis Prognosis genome wide scan genetic consortium

Volumetric assessment of hepatic grafts using a light detection and ranging system for 3D scanning:Preliminary data

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World Journal of Hepatology 2022年第7期14卷 1504-1511页

作者： ge.rgios katsanos Konstantina-Eleni Karakasi Ion-Anastasios Karolos Athanasios Kofinas Nikolaos Antoniadis Vassilios Tsioukas ge.rgios Tsoulfas Department of Transplantation Medical SchoolAristotle University of ThessalonikiHippokration General HospitalThessaloniki 54642Greece Department of Rural and Surveying Engineering Aristotle University of ThessalonikiThessaloniki 54642Greece

BACKGROUND Liver transplantation has evolved into a safe life-saving operation and remains the golden standard in the treatment of end stage liver *** main limiting factor in the application of liver transplantation is graft *** strategies have been developed in order to alleviate graft shortage,such as living donor partial liver transplantation and split liver transplantation for adult and pediatric *** these strategies,liver volume assessment is of paramount importance,as size mismatch can have severe consequences in the success of liver *** To evaluate the safety,feasibility,and accuracy of light detection and ranging(LIDAR)3D photography in the prediction of whole liver graft volume and *** Seven liver grafts procured for orthotopic liver transplantation from brain deceased donors were prospectively measured with an LIDAR handheld camera and their mass was calculated and compared to their actual *** The mean error of all measurements was 17.03 g(range 3.56-59.33 g).Statistical analysis of the data yielded a Pearson correlation coefficient index of 0.9968,indicating a strong correlation between the values and a Student’s t-test P value of *** accuracy of the measurements was calculated at 97.88%.CONCLUSION Our preliminary data indicate that LIDAR scanning of liver grafts is a safe,cost-effective,and feasible method of ex vivo determination of whole liver volume and *** data are needed to determine the precision and accuracy of this method.

关键词： Light detection and ranging Graft volume 3dscan Ex vivo volumetry Liver grafts

Hepatic ischemia-reperfusion syndrome and its effect on the cardiovascular system: The role of treprostinil, a synthetic prostacyclin analog

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世界胃肠外科杂志:英文版(电子版) 2023年第9期15卷 1858-1870页

作者： Christina Mouratidou Efstathios T Pavlidis ge.rgios katsanos Serafeim-Chrysovalantis Kotoulas Eleni Mouloudi ge.rgios Tsoulfas Ioannis N Galanis Theodoros E Pavlidis Intensive Care Unit Hippokration General HospitalThessaloniki 54642Greece 2^(nd)Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece Department of Transplantation Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Hepatic ischemia-reperfusion syndrome has been the subject of intensive study and experimentation in recent decades since it is responsible for the outcome of several clinical entities,such as major hepatic resections and liver *** addition to the organ’s post reperfusion injury,this syndrome appears to play a central role in the dysfunction of distant tissues and ***,continuous research should be directed toward finding effective therapeutic options to improve the outcome and reduce the postoperative morbidity and mortality *** is a synthetic analog of prostaglandin I2,and its experimental administration has shown encouraging *** has already been approved by the Food and Drug Administration in the United States for pulmonary arterial hypertension and has been used in liver transplantation,where preliminary encouraging results showed its safety and feasibility by using continuous intravenous administration at a dose of 5 ng/kg/*** improves renal and hepatic function,diminishes hepatic oxidative stress and lipid peroxidation,reduces hepatictoll-like receptor 9 and inflammation,inhibits hepatic apoptosis and restores hepatic adenosine triphosphate(ATP)levels and ATP synthases,which is necessary for functional maintenance of *** exhibits vasodilatory properties and antiplatelet activity and regulates proinflam-matory cytokines;therefore,it can potentially minimize ischemia-reperfusion ***,it may have beneficial effects on cardiovascular parameters,and much current research interest is concentrated on this compound.

关键词： Hepatic ischemia-reperfusion syndrome Myocardial damage Prostaglandins Treprostinil Liver transplantation Hepatectomy