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Complications of modern pancreaticoduodenectomy:A systematic review and meta-analysis

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Hepatobiliary & Pancreatic Diseases International 2022年第6期21卷 527-537页

作者： Stamatios Kokkinakis Evangelos I Kritsotakis Neofytos Maliotis Ioannis Karageorgiou Emmanuel Chrysos konstantinos Lasithiotakis Department of General Surgery University General Hospital of HeraklionHeraklionCrete 71110Greece Laboratory of Biostatistics Division of Social MedicineSchool of MedicineUniversity of CreteHeraklionCrete 71110Greece

Background:In the past decades,the perioperative management of patients undergoing pancreaticoduo-denectomy(PD)has undergone major changes *** review aimed to systematically determine the burden of complications of PD performed in the last 10 *** sources:A systematic review was conducted in PubMed for randomized controlled trials and ob-servational studies reporting postoperative complications in at least 100 PDs from January 2010 to April *** of bias was assessed using the Cochrane RoB2 tool for randomized studies and the method-ological index for non-randomized studies(MINORS).Pooled complication rates were estimated using random-effects *** was investigated by subgroup analysis and ***:A total of 20 randomized and 49 observational studies reporting 63229 PDs were *** MINORS score showed a high risk of bias in non-randomized studies,while one quarter of the ran-domized studies were assessed to have high risk of *** incidences of 30-day mortality,overall complications and serious complications were 1.7%(95%CI:0.9%-2.9%;I 2=95.4%),54.7%(95%CI:46.4%-62.8%;I 2=99.4%)and 25.5%(95%CI:21.8%-29.4%;I 2=92.9%),***-relevant postopera-tive pancreatic fistula risk was 14.3%(95%CI:12.4%-16.3%;I 2=92.0%)and mean length of stay was 14.8 days(95%CI:13.6-16.1;I 2=99.3%).Meta-regression partially attributed the observed heterogeneity to the country of origin of the study,the study design and the American Society of Anesthesiologists ***:Pooled complication rates estimated in this study may be used to counsel patients scheduled to undergo a PD and to set benchmarks against which centers can audit their ***,cautious interpretation is necessary due to substantial heterogeneity.

关键词： Pancreaticoduodenectomy Postoperative complications Meta-analysis Postoperative pancreatic fistula

Segmental liver incarceration through a recurrent incisional lumbar hernia

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Hepatobiliary & Pancreatic Diseases International 2007年第4期6卷 442-444页

作者： Nikolaos S. Salemis konstantinos Nisotakis Stavros Gourgiotis Efstathios Tsohataridis Second Department of Surgery Army Veterans General Hospital Athens Greece Second Department of Surgery Army General Hospital Athens Greece

BACKGROUND:Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after flank surgery. Incarceration or strangulation of hernia contents is uncommon. METHOD:Segmental liver incarceration through a recurrent incisional lumbar defect was diagnosed in a 58 years old woman by magnetic resonance imaging. RESULTS:The patient underwent an open repair of the com-plicated hernia. An expanded polytetraflouoroethylene(e-PTFE) mesh was fashioned as a sublay prosthesis. She had an uncomplicated postoperative course. Follow-up examinations revealed no evidence of recurrence. CONCLUSIONS:Although lumbar hernia rarely results in incarceration or strangulation,early repair is necessary because of the risks of complications and the increasing difficulty in repairment as it enlarges. Surgical repair is often difficult and challenging.

关键词： lumbar hernia incisional liver incarceration

Acute esophageal necrosis: A systematic review and pooled analysis

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World Journal of Gastrointestinal Surgery 2020年第3期12卷 104-115页

作者： Dimitrios Schizas Nikoletta A Theochari konstantinos S Mylonas Prodromos Kanavidis Eleftherios Spartalis Stamatina Triantafyllou konstantinos P Economopoulos Dimitrios Theodorou Theodore Liakakos First Department of Surgery National and Kapodistrian University of AthensLaikon General HospitalAthens 11527Greece Department of Medicine Surgery Working GroupSociety of Junior DoctorsAthens 15122Greece Laboratory of Experimental Surgery and Surgical Research N.S.Christeas National and Kapodistrian University of AthensAthens 11527Greece First Propedeutic Department of Surgery National and Kapodistrian University of AthensHippocration General HospitalAthens 11527Greece Department of Surgery Duke University Medical CenterDurhamNC 27708United States

BACKGROUND Acute esophageal necrosis(AEN)is a rare entity with multifactorial etiology,usually presenting with signs of upper gastrointestinal *** To systematically review all available data on demographics,clinical features,outcomes and management of this medical *** A systematic literature search was performed with respect to the PRISMA statement(end-of-search date:October 24,2018).Data on the study design,interventions,participants and outcomes were extracted by two independent *** Seventy-nine studies were included in this ***,114 patients with AEN were identified,of whom 83 were males and 31 *** patient age was 62.1±*** most common presenting symptoms were melena,hematemesis or other manifestations of gastric bleeding(85%).The lower esophagus was most commonly involved(92.9%).The most widely implemented treatment modality was conservative treatment(75.4%),while surgical or endoscopic intervention was required in 24.6%of the *** overall followup was 66.2±101.8 *** 29.9%of patients died either during the initial hospital stay or during the follow-up *** symptoms on presentation[Odds ratio 3.50(1.09-11.30),P=0.03]and need for surgical or endoscopic treatment[surgical:Odds ratio 1.25(1.03-1.51),P=0.02;endoscopic:Odds ratio 1.4(1.17-1.66),P<0.01]were associated with increased odds of complications.A sub-analysis separating early versus late cases(after 2006)revealed a significantly increased frequency of surgical or endoscopic intervention(9.7%vs 30.1%respectively,P=0.04)CONCLUSION AEN is a rare condition with controversial pathogenesis and unclear optimal *** the frequency of surgical and endoscopic intervention has increased in recent years,outcomes have remained the ***,further research work is needed to better understand how to best treat this potentially lethal disease.

关键词： Acute esophageal necrosis Black esophagus Acute necrotizing esophagitis

Colonoscopy attachments for the detection of precancerous lesions during colonoscopy:A review of the literature

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World Journal of Gastroenterology 2018年第37期24卷 4243-4253页

作者： Paraskevas Gkolfakis Georgios Tziatzios Eleftherios Spartalis Ioannis S Papanikolaou konstantinos Triantafyllou Hepatogastroenterology Unit Second Department of Internal Medicine-PropaedeuticResearch Institute and Diabetes CenterMedical SchoolNational and Kapodistrian University of Athens''Attikon”University General HospitalAthens 12462Greece Laboratory of Experimental Surgery and Surgical Research National and Kapodistrian University of AthensAthens 12462Greece

Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting up to almost one fourth of existing adenomas. Among reasons accounting for such failures, is the inability to meticulously visualize the colonic mucosa located either proximal to haustral folds or anatomic curves, including the hepatic and splenic flexures. In order to overcome these limitations, various colonoscope attachments aiming to improve mucosal visualization have been developed. All of them-transparent cap, Endocuff, Endocuff Vision and Endorings-are simply mounted onto the distal tip of the scope. In this review article, we introduce the rationale of their development, present their mode of action and discuss in detail the effect of their implementation in the detection of lesions during colonoscopy.

关键词： Adenoma detection rate Adenoma miss rate Colonoscopy Cup Endocuff Endocuff Vision Endorings

Short vs long-course antibiotic therapy in adults with acute cholangitis:A systematic review,meta-analysis,and evidence quality assessment

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World Journal of Gastroenterology 2023年第19期29卷 3027-3039页

作者： Karampet Kasparian Chrysanthos D Christou konstantinos Petidis Michail Doumas Olga Giouleme Clinic of Oncology Gastroenterology and HematologyAlfried Krupp HospitalEssen 45131Germany Second Propedeutic Department of Internal Medicine Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54642Greece Department of Transplantation Surgery Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54642Greece

BACKGROUND Acute cholangitis(AC)constitutes an infection with increased mortality rates in the *** to new diagnostic tools and therapeutic methods,the mortality of AC has been significantly reduced *** initial antibiotic treatment of AC has been oriented to the most common pathogens connected to this ***,the optimal duration of the antibiotic treatment of AC is still *** To investigate if shorter-course antibiotic treatments could be similarly effective to long-course treatments in adults with *** This study constitutes a systematic review and meta-analysis of the existing literature concerning the duration of antibiotic therapy of AC and an assessment of the quality of the *** study was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Review and *** studies were included in the systematic review,and eight were eligible for *** to heterogeneous duration cutoffs,three study-analysis groups were formed,with a cutoff of 2-3,6-7,and 14 *** A total of 2763 patients were included in the systematic review,and 1313 were accounted for the *** mean age was 73.66±14.67 years,and the male and female ratio was 1:*** significant differences were observed in the mortality rates of antibiotic treatment of 2-3 d,compared to longer treatments(odds ratio=0.78,95% confidence interval:0.23-2.67,I2=9%)and the recurrence rates and hospitalization length were also not different in all study *** Short-and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of *** conclusions cannot be extracted concerning the hospitalization duration.

关键词： Acute cholangitis Antibiotic Short-course Long-course Antimicrobial Treatment duration

Endoscopic treatment of scarred polyps with a non-thermal device(Endorotor):A review of the literature

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World Journal of Gastroenterology 2024年第12期30卷 1706-1713页

作者： Mariam Zaghloul Hameed Rehman Stefano Sansone konstantinos Argyriou Adolfo Parra-Blanco Department of Hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversitKafr-Elshikh 33516Egypt Department of Gastroenterology Service Nottingham City Hospital CampusNottingham University Hospitals NHS TrustNottingham NG51PBUnited Kingdom Department of Gastroenterology University Hospital of LarissaLarissa 41334Greece NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and University of NottinghamNottingham NG72UHUnited Kingdom

Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic *** procedures have evolved over the past few years from endoscopic mucosal resection(EMR)to more advanced techniques,such as endoscopic submucosal dissection and endo-scopic full-thickness *** resection and disease eradication are the ultimate goals of ER-based techniques,and novel devices have been developed to achieve these *** EndoRotor®Endoscopic Powered Resection System(Interscope Medical,Inc.,Northbridge,Massachusetts,United States)is one such *** EndoRotor is a powered resection tool for the removal of alimentary tract mucosa,including post-EMR persistent lesions with scarring,and has both CE Mark and FDA *** review covers available published evidence documenting the usefulness of EndoRotor for the management of recurrent colorectal polyps.

关键词： EndoRotor Scarred polyps Recurrent polyps Colorectal cancer Colorectal polyps

New guidelines for the diagnosis and management of pulmonary embolism:Key changes

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World Journal of Cardiology 2020年第5期12卷 161-166页

作者： Anastasia Erythropoulou-Kaltsidou Stelina Alkagiet konstantinos Tziomalos First Propedeutic Department of Internal Medicine Medical SchoolAristotle University of ThessalonikiAHEPA HospitalThessaloniki 54636Greece Department of Cardiology Georgios Papanikolaou HospitalThessaloniki 57010Greece

Pulmonary embolism(PE)is an important public health *** August2019,the European Society of Cardiology in collaboration with the European Respiratory Society released new guidelines for the diagnosis and management of *** discuss the basic changes between these recent guidelines and the previous guidelines that were published in *** diagnosis,the new guidelines propose the use of an age-adjusted cut-off level of D-dimers instead of a fixed cut-off value.A D-dimer test adapted to clinical possibility should also be considered instead of fixed cut-off level of *** recommendations for the diagnosis of PE during pregnancy are also *** risk stratification,assessment of PE-related early mortality risk is ***,the importance of right ventricular dysfunction is emphasized in lowrisk *** further risk stratification of the severity of PE in patients without hemodynamic instability,use of validated scores that combine clinical,imaging and laboratory PE-related prognostic factors might also be *** treatment,the possibility of early discharge is mentioned in patients without severe comorbidities,who are not of high risk for sudden death and in whom proper medical management at home and proper medical follow up can be *** new guidelines also suggest that pro-brain natriuretic peptide levels,right ventricular function and the presence of thrombus in the right heart could be useful for guiding the decision of early ***,these new guidelines introduce several key changes and knowledge and adherence to them will improve the outcome of patients with PE.

关键词： Pulmonary embolism Guidelines Diagnosis Treatment D-dimers Pregnancy

Wave propagation through disordered media without backscattering and intensity variations

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Light(Science & Applications) 2017年第1期6卷 623-629页

作者： konstantinos G Makris Andre Brandstötter Philipp Ambichl Ziad H Musslimani Stefan Rotter Crete Center for Quantum Complexity and Nanotechnology Department of PhysicsUniversity of CreteHeraklion 71003Greece Institute for Theoretical Physics Vienna University of Technology(TU-Wien)Vienna 1040Austria Department of Mathematics Florida State UniversityTallahasseeFL 32306USA

A fundamental manifestation of wave scattering in a disordered medium is the highly complex intensity pattern the waves acquire due to multi-path *** we show that these intensity variations can be entirely suppressed by adding disorder-specific gain and loss components to the *** resulting constant-intensity waves in such non-Hermitian scattering landscapes are free of any backscattering and feature perfect transmission through the *** experimental demonstration of these unique wave states is envisioned based on spatially modulated pump beams that can flexibly control the gain and loss components in an active medium.

关键词： Anderson localisation complex media non-Hermitian physics scattering

Systematic review of novel ablative methods in locally advanced pancreatic cancer

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World Journal of Gastroenterology 2014年第9期20卷 2267-2278页

作者： Margaret G Keane konstantinos Bramis Stephen P Pereira Giuseppe K Fusai Institute for Liver and Digestive Health University College London Royal Free Campus London NW3 2PF United Kingdom HPB and Liver Transplant Unit Royal Free Hospital London NW3 2QG United Kingdom

Unresectable locally advanced pancreatic cancer with or without metastatic disease is associated with a very poor *** standard therapy is limited to chemotherapy or *** regimens have been shown to have a substantial survival advantage and novel treatment strategies are urgently *** and laser based ablative techniques are widely used in many solid organ *** studies in the pancreas were associated with significant morbidity and mortality,which limited widespread *** to the various applications,in particular combining the techniques with high quality imaging such as computed tomography and intraoperative or endoscopic ultrasound has enabled real time treatment monitoring and significant improvements in *** conducted a systematic review of the litera-ture up to October *** studies suggest that ablative therapies may confer an additional survival benefit over best supportive care but randomised studies are required to validate these findings.

关键词： Pancreatic cancer Radiofrequency ablation Photodynamic therapy Cryoablation Microwave ablation High frequency focused ultrasound Irreversible electroporation